Doctors should avoid using prescription NSAIDs in patients with heart disease and proceed “with caution” in patients with cardiovascular risk factors, the TGA advises.

In its latest Medicines Safety Update  it also recommends doctors individually assess each patient to ensure the benefits outweigh the risks.

“Consider advising patients of the increased cardiovascular risks of using NSAIDs, including OTC products, and educating them regarding the signs and symptoms of serious cardiovascular events. Instruct them to seek medical attention immediately if they experience any,” the advisory said.

“Be aware that, in rare cases, diclofenac has been associated with a risk of hepatotoxicity and should be used at the lowest effective dose for only short periods of time,” it added.

The advice is based on a review into the safety of prescription NSAIDs and COX-2 inhibitors including diclofenac, naproxen, ibuprofen, celecoxib, etoricoxib, indomethacin, meloxicam and piroxicam.

It  found that use of OTC NSAIDs was safe when they were used according to the recommended doses for short durations, as instructed on the label. However, inappropriate use could pose a significant risk. Current product labelling for OTC diclofenac, naproxen and ibuprofen did not carry strong enough warnings, and the TGA is currently considering submissions to this particular inquiry.

The full NSAIDs and diclofenac reviews are available on the TGA website, as well as a ‘questions and answers’ resource for consumers.