2 NSAIDs for a patient aged 81

[kemzero]

Had a script for a 81 year old patient with gout for Indomethacin 150mg od (divided doses), Ibuprofen 1200mg(dd) , allopurinol 300mg od and bendrofluazide 2.5mg ( for his BP)

As the script didn't seem clinically appropriate ( code of ethics ) rang about the 2 NSAIDs , one got dropped, but then patient wanted to know why his uric acid levels were high etc...had to explain it was the thiazide ....as this is first line in elders , what would you advice GP, if you were asked....try an ACE-1 low dose ?

By the way --this isn't an MUR, just run of the mill stuff I guess (not that we get paid for it)

[johnep]

When I am working I take 2 x celebrex 100mg, 2 x Aspirin 300mg and 2 x paracetamol in the morning.
johnep

[kemzero]

Originally Posted by johnep

When I am working I take 2 x celebrex 100mg, 2 x Aspirin 300mg and 2 x paracetamol in the morning.
johnep

From previous posts,Johnep , I'm I right to assume you are over 65..., sorry if you think I am being forward

1.Celebrex should only be prescribed in patients who can't tolerate the non selective NSAIDs
but since you already take Aspirin, you shouldn't really be on celebrex, (NICE)
2.Over 65s shouldn't really take NSAIDs ,particularly high dose ones as they cause salt water retention (MHRA ,CSM)
3.I hope you don't suffer from high BP, if you do, its time to review your NSAID intake

[Jeff]

Originally Posted by kemzero

From previous posts,Johnep , I'm I right to assume you are over 65..., sorry if you think I am being forward

1.Celebrex should only be prescribed in patients who can't tolerate the non selective NSAIDs
but since you already take Aspirin, you shouldn't really be on celebrex, (NICE)
2.Over 65s shouldn't really take NSAIDs ,particularly high dose ones as they cause salt water retention (MHRA ,CSM)
3.I hope you don't suffer from high BP, if you do, its time to review your NSAID intake

Yes - johnep should stay in pain unable to go to work because that way he might live longer and it would help with the excess number of pharmacists.

I'm all for giving patients information about their medicines and explaining the pro's and cons - but the decision on risk vs benefit is an agreement between prescriber and patient not a paternalistsic NICE says you shouldn't do that.

Jeff