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GPs attack 'patronising' NSAID guidance

Updated guidance that seeks to restrict GP prescribing of NSAIDs has been dismissed as patronising by GP rheumatology specialists.

Guidance from the Medicines and Healthcare Products Regulatory Agency recommends piroxicam should be only initiated by specialists as second-line arthritis treatment.

And ketorolac should only be initiated in hospital, because of the risk of gastrointestinal adverse effects.

But Dr Adam Bajkowski, president of the Primary Care Rheumatology Society, dismissed the guidance as ‘ridiculous'.

‘GPs do not prescribe sweets. I do not think this is above the average GP.'

NSAIDs carried some degree of risk that even specialists could not predict, he added.

Dr Iain Gilchrist, a GP in Bishop's Stortford, Hertfordshire, said that while piroxicam had relatively high GI toxicity compared with other NSAIDs, its use was not ‘beyond the scope of GPs'.

But Dr Donal Hynes, a GP in Somerset and professional executive chair of Somerset Coast PCT, said piroxicam was a ‘special case'.

‘Most GPs will find they can satisfy their patients with the other NSAIDs,' he said.

Consultant rheumatologist at the Trafford General Hospital, Dr Frank McKenna, said the piroxicam guidance was ‘inappropriate' as the drug's toxicity stemmed from its long half-life and that it is usually given at full dose.

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