Generally, NSAIDs are prescribed for pain associated with the inflammatory arthritides (e.g. rheumatoid arthritis), osteoarthritis, musculoskeletal disorders, dysmenorrhea, and mild to moderate pain. The indications are licensed specifically for each agent and are found in the general pharmacopoeia for each country. The absolute and relative contraindications are also specified in the license for each agent but again some general principles apply. These include a history of hypersensitivity to aspirin or other NSAIDs, first trimester of pregnancy due to risk of mis-carriage,12 and those with coagulation disturbances. Caution should be used when prescribing for the elderly, lactating mothers, and those with renal, hepatic, or cardiac impairment.13 The other common caution is for patients with a history of gastrointestinal ulceration or bleeding. For a comprehensive list, please refer to Chapter 4, Clinical pharmacology: traditional NSAIDs and selective COX-2 inhibitors in the Acute Pain volume of this series.
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