NSAID GI Risk Strategizer NSAID GI Risk SCORE Card

To determine your patient’s SCORE (Standardized Calculator of Risk for Events), SHORT Term Planned DURATION LONG Term enter the points in the right-hand column corresponding to the appropriate answer (©Stanford University). The total of the points is the patient’s SCORE. POINTS (prn) of Therapy? (chronic use) 1. Patient’s age in years? 66 – 70 13 points 46 – 50 8 points 71 – 75 14 points 51 – 55 9 points 76 – 80 16 points History of HOSPITALIZATION 56 – 60 10 points 81 – 85 17 points No for GI Bleed or Ulcer ? Yes 61 – 65 12 points >85 18 points

2. Current health status as rated by the patient ? Very Well 0 points Poor 3 points Well 1 point Very Poor 4 points Patient’s AGE ? Fair 2 points

< 50 51-65 > 65 3. Does patient have rheumatoid arthritis ? No 0 points Yes 2 points

4. Use of oral prednisone or other oral steroids in past year? See other side : 0 mo 0 points 7-10 mo 4 points History of RA NSAID GI Risk 1-3 mo 1 point 11-12 mo 5 points or Long-term SCORE Card 4-6 mo 3 points

Steroid Use ? Consider Non-drug therapy, 5. Hospitalized for a GI bleed or an ulcer? ( If “Yes”, skip #6) No Yes Acetaminophen &/or Narcotics No 0 points Yes 8 points

Has patient had GI side effects when taking NSAIDS? 6. No 0 points Yes 2 points

Use Non-pharmacological Therapy &/or Acetaminophen, or Prescribe Total SCORE (add all points):

an Average or Low GI Toxicity NSAID : • OTC Ibuprofen (Advil) 200 mg 2 tabs TID - QID TREATMENT RECOMMENDATIONS* • OTC Naproxen (Aleve) 220 mg q 8-12 hrs Consider non-drug therapies as a first step and as an • Ibuprofen (Motrin) 600 - 800 mg TID - QID Total SCORE • Naproxen (Naprosyn/Anaprox) 375 - 500 mg BID adjunct to drug therapy • Sulindac (Clinoril) 150 - 200 mg BID RISK LEVELS 1 & 2 • Ibuprofen (Motrin) 600 - 800 mg TID ______• Naproxen (Naprosyn) 375 - 500 mg BID • < 15 points • Sulindac (Clinoril) 150 - 200 mg BID Nabumetone (Relafen) 500 mg 1 - 2 tabs BID • Salsalate (Disalcid) 500 - 750 mg 2 tabs BID (Lowest Risk) • Any agent from Risk Level 3 below • Etodolac (Lodine) 300 - 400 mg BID - TID RISK LEVEL 3 • Meloxicam (Mobic) 7.5 - 15 mg daily • Meloxicam (Mobic) 7.5 - 15 mg daily • Nabumetone (Relafen) 500 mg 1-2 tabs BID 16 – 20 points • Etodolac (Lodine) 300 - 400 mg BID -TID The package inserts of all marketed NSAIDs and celecoxib (Celebrex) have a boxed • Salsalate (Disalcid) 500 - 750 mg 2 tabs BID warning highlighting the potential for increased risk of cardiovascular (CV) events and RISK LEVEL 4 • Acetaminophen gastrointestinal bleeding associated with these drugs. An FDA mandated patient • Acetaminophen with codeine or hydrocodone information sheet is required for all prescription NSAIDs including celecoxib. points • Rofecoxib (Vioxx) and valdecoxib (Bextra), both COX-2 inhibitors, were withdrawn > 20 Meloxicam (Mobic) 7.5 - 15 mg daily + from the market due to their increased risk of CV events. Omeprazole* 20 mg daily (Highest Risk) • Nabumetone (Relafen) 500 mg 1 - 2 tabs BID +

COX-2 inhibitors : Omeprazole* 20 mg daily • Are NO better at relieving pain and inflammation than NSAIDs • Etodolac (Lodine) 300 - 400 mg BID -TID + • Have similar rates of dyspepsia and nausea as NSAIDs Omeprazole* 20 mg daily • Cause adverse renal, HTN, and CHF effects similar to NSAIDs • Salsalate (Disalcid) 500 - 750 mg 2 tabs BID + • Do NOT eliminate the risk of GI bleeding . Any potential GI-protective benefit Omeprazole* 20 mg daily appears to be lost with low-dose aspirin use * Omeprazole 20 mg is also available over-the-counter as Prilosec OTC For more information: pharmacy.kp.org (Drug FAQs) (14 tablets per package). rev. 9/07