Download NSAIDs - Harrogate and Rural District CCG

Unit 1
St James Business Park
Grimbald Crag Court
Knaresborough
HG5 8QB
Our ref:
MMT/AdvisoryNote/NSAIDs
Date
December 2016
To:
Practice Prescribing Leads
Practice Managers
Re:
NSAIDs
Dear Colleague,
For the December “Hints and Tips on Prescribing”, the Medicines Management Team would like to
encourage practices to review patients who are prescribed NSAID preparations which do not have a good
evidence base for their use or where there are more cost-effective alternatives.
General advice
 If an NSAID is needed then prescribe the lowest dose for the shortest duration, e.g. ibuprofen
≤1200mg daily in divided doses) or naproxen (≤1000mg daily in divided doses). These are
associated with a lower cardiovascular risk than other NSAIDs.

Regularly review the appropriateness of NSAID prescribing, especially in people who are at higher
risk of both gastrointestinal and cardiovascular and renal morbidity and mortality, e.g. older people.
If a NSAID is needed, consider switching to a lower risk agent where appropriate.

When prescribing a NSAID consider the need for PPI, especially if the patient is at high risk of a GI
bleed, e.g. aged over 65, or on long term treatment with a NSAID.

Enteric coated NSAIDs do not provide sufficient gastro protection. A non ec NSAID and a PPI
should be used instead, if the patient is at risk of GI events.

PPIs currently recommended HaRD are:
 Omeprazole 20mg od
 Lansoprazole 15 - 30mg od
Enteric coated naproxen in HaRD CCG - 6months to Oct 2016
NSAIDs
Monthly briefing/letter – Dec 16
Page 1 of 2
HaRD Medicines Management Team
Action points
Please check if any of the following are prescribed in your practice:
 Enteric coated naproxen - consider changing to plain naproxen with a PPI if necessary, as this is
more cost-effective.

NSAID / PPI combination products, e.g. Vimovo, as these are much more expensive than
prescribing a NSAID and a PPI separately.

Arthrotec 50 or Arthrotec 75 containing diclofenac and misoprostol. A PPI is recommended for
gastroprotection for patients on a NSAID, (rather than misoprostol), and naproxen or ibuprofen are
the preferred NSAIDs as they are associated with a lower thrombotic risk than other NSAIDs.

Branded products of NSAIDs, e.g. Naprosyn, Voltarol SR, Voltarol dispersible, Voltarol ec,
Diclomax SR, Diclomax Retard. Please prescribe generically.
Diclofenac / misoprostol combinations in HaRD CCG – 6months to Oct 2016.
Practice
BEECH HOUSE SURGERY
CHURCH AVENUE MEDICAL GROUP
CHURCH LANE SURGERY
DR AKESTER & PTRS
DR INGRAM & PTRS
EAST PARADE SURGERY
EASTGATE MEDICAL GROUP
KINGSWOOD SURGERY
NIDDERDALE GROUP PRACTICE
NORTH HOUSE SURGERY
PARK PARADE SURGERY
RIPON SPA SURGERY
SPRINGBANK SURGERY
STOCKWELL ROAD SURGERY
THE LEEDS ROAD PRACTICE
THE MOSS PRACTICE
THE SPA SURGERY
Total Items Total Cost
13
£187.14
6
£110.61
7
£124.81
0
£0.00
20
£266.09
3
£31.40
31
£367.37
11
£165.60
4
£58.63
1
£14.65
0
£0.00
20
£241.67
0
£0.00
7
£109.53
5
£73.76
26
£345.51
9
£127.18
163 £2,223.97
Our Prescribing Support Team is available to help practices with this work if required. HaRD versions of
OptimiseRx and SystmOne and EMIS formularies will be amended to incorporate these recommendations.
Local community pharmacies have been e-mailed to inform them that practices will be undertaking this
switch. As the timings of the switch will vary between practices it is advisable that each practice notifies its
local pharmacies in advance of the switch, to enable effective management of stock.
Should you have any queries, recommendations or ideas about this or future initiatives then we would be
pleased to hear from you.
Yours sincerely,
The Medicines Management Team, HaRD CCG.
References
1. eBNF accessed 23.11.16
2. Department of Health Drug Tariff. Accessed on-line 23.11.16
3. NICE Key Therapeutic Topic NSAIDS Feb 2015.
NSAIDs
Monthly briefing/letter – Dec 16
Page 2 of 2
HaRD Medicines Management Team