Keeping the Kidneys Safe: The Pharmacists’ Role in NSAID Avoidance

While non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen are very easy to purchase (in grocery stores and gas stations), they are one of the most common medications improperly prescribed, especially to older adults. If these are used at a high dose regularly and combined with the wrong medications, it can lead to acute kidney injury (AKI). NSAIDs inhibit the cyclooxygenase enzyme, preventing prostaglandin production. Prostaglandins help to autoregulate the dilation of arterioles in the kidney, controlling the amount of blood filtered. If AKI goes untreated long enough, self-prescribing NSAIDs can even lead to chronic kidney disease (CKD). Luckily, there are strategies that pharmacists can use to prevent patients from overusing NSAIDs at home and prevent these adverse effects.

Pharmacists can use bright stickers or post-it notes on the prescriptions of those who need medication counseling due to a high risk for AKI or CKD (patients with hypertension or diabetes). This will help the staff to remember to discuss the patient’s personal pain management system during consultations, blood pressure screenings, or when handing out the prescription. If the patient is in a rush, a handout could also be placed in with the prescription or on a pamphlet table so that the information is still available. They can also help to counsel on when to use ice or heat on a musculoskeletal issue, rather than taking an NSAID to relieve pain. This gives the patient other ways to manage their pain without taking an NSAID too frequently.

Acetaminophen could also be recommended as a pain reliever for those who are at high risk for AKI or CKD, as it is metabolized in the liver more than the kidney and is rarely seen to damage the kidney. However, this will then require that the pharmacist counsel on the maximum daily dose for acetaminophen in combination with other acetaminophen-containing medications the patient may have. This would be an optimal alternative if the patient is insistent on taking a pill for their pain, as long as the proper counseling regarding acetaminophen can be delivered.


I felt that this article had a lot of good options for educating patients with increased risk for kidney injuries against NSAID use. The repetition of seeing a helpful handout with the patient’s prescription would demonstrate the importance of the issue. The handout could serve as an additional reminder each time the patient has their prescription filled to steer clear of NSAIDs and use another pain-relieving method. This article also ties in nicely with what we are currently learning in anatomy and physiology and helped my understanding of kidney damage via non-steroidal anti-inflammatory drugs.

http://www.japha.org/article/S1544-3191(15)30021-2/fulltext

Pai, Amy B. “Keeping kidneys safe: The pharmacists’ role in NSAID avoidance in high-risk patients.” Journal of the American Pharmacists Association. 55.1 (2015) e15-e25. Web. 14 February 2016.

2 thoughts on “Keeping the Kidneys Safe: The Pharmacists’ Role in NSAID Avoidance”

  1. I really like this article, and your analysis of its key points. I often feel that OTC safety is overlooked in the public, especially as it concerns NSAID therapy. I know a lot of my friends and relatives are very cavalier about taking Motrin or Aleve, and often do not consider chronic use for pain relief to pose any serious threat to their kidneys. I like the idea of pharmacists being able to counsel patients with an NSAID prescription or at least give them information to increase awareness about the caution that should be exercised when taking OTC medications. It might also be a good idea to consider methods of distributing information for kidney health with NSAIDs sold without a prescription.

  2. I think that this article is great and really makes me as a student pharmacist aware of some things I never thought of before. For instance, the use of NSAIDs and like stated, self-prescribing NSAIDs is extremely high. When you have minor pain, you always go to take so Advil. But medications need to be carefully considered for each population of patients. It is an important role of the pharmacist to take into consideration all parameters of a patient and get all of their medication history. From this point, the pharmacist will be able to counsel on what they think necessary and NSAIDs may now be one of them.

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