TABLE 2.

Summary of recommendations from the Third Canadian Consensus Conference regarding an evidence-based approach to prescribing nonsteroidal anti-inflammatory drugs (NSAIDs)

	Recommendation
Patient-physician communication	Patients should be fully informed about evolving information regarding the benefits and risks of their treatment options.
Indications	NSAIDs, including COXIBs, are generally more effective and preferred by patients over acetaminophen, although a trial of acetaminophen is warranted in some patients.
Gastrointestinal toxicity	In patients with risk factors for perforations, ulcers and gastric bleeding, a COXIB is the NSAID of choice, depending on the patient’s cardiovascular risks.
	If NSAIDs must be used in high-risk patients with a history of gastrointestinal bleeding, a proton pump inhibitor should be prescribed as well.
	NSAIDs can adversely affect the entire gastrointestinal tract; however, the prevalence of clinically relevant NSAID-associated lower gastrointestinal disease is unclear.
Renal issues	Before starting an NSAID or COXIB, determine renal status and creatinine clearance in patients older than 65 years or in those with comorbid conditions that may affect renal function.
	Advise patients that if they cannot eat or drink that day, they should withhold that day’s dose of NSAID/COXIB.
Hypertension	In patients receiving antihypertensive drugs, remeasure blood pressure within a few weeks after initiating NSAID therapy and monitor appropriately; drug doses may need to be adjusted.
Cardiovascular events	Patients on rofecoxib have been shown to have an increased risk of cardiovascular events, and data suggest that this risk may be an effect of the NSAID/COXIB class. Physicians and patients should weigh the benefits and risks of therapy.
Geriatric considerations	NSAIDs/COXIBs should be used with caution in elderly patients, who are at greatest risk of serious gastrointestinal, renal and cardiovascular side effects.

Data from reference 27. COXIBS Cyclo-oxygenase-2 selective inhibitors