Box 1: Recommendations for doctors-high risk patients

1.		Document patient’s history and carry out necessary laboratory investigations before starting any treatment
2.		For high-risk patients, avoid NSAIDs and use alternate management strategies like physiotherapy and/or exercise to ease pain and inflammation in diseases like OA
3.		Consider prescribing low doses and shorter durations for diseases that require instant relief (headache, dysmenorrhea, post-operative pain)
4.		Consider pulse therapy - prescribing large doses NSAIDs in an intermittent manner to enhance the therapeutic effect and reduce the GI complications/other adverse events in chronic diseases
5.		Avoid prescribing NSAIDs with other drugs (SSRIs, antiplatelet drugs, corticosteroids)
6.		Inform the patient that NSAIDs can be taken “as required” and generally do not have a fixed schedule
7.		Prefer selective COX-2 inhibitors like coxibs or safer drugs like amtolmentinguacyl over conventional NSAIDs
8.		Prescribe double dose of gastroprotective agents like PPIs in patients undergoing long-term (>30 days) NSAID treatment
9.		Prescribe a single dose of PPI (up to 30 days) in patients undergoing NSAID treatment
10.		Perform periodic assessment of patients on long-term NSAID therapy for early identification of signs/symptoms of gastropathy

Abbreviations: COX-2, cyclooxygenase-2; GI, gastrointestinal; NSAID, non-steroidal anti-inflammatory drug; OA, osteoarthritis; SSRI, selective serotonin reuptake inhibitor