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NSAIDs in renal impairment — GPhC CRA MCQ

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ModerateMusculoskeletal TherapeuticsNSAIDs in renal impairmentGPhC CRA

A 68-year-old man with chronic kidney disease (eGFR 28 mL/min/1.73m2) and gout presents requesting naproxen over the counter for a flare. He currently takes allopurinol 100 mg once daily and amlodipine 5 mg once daily. What is the most appropriate response?

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Correct answer: A — Refuse the sale and refer to his GP as NSAIDs are contraindicated in severe renal impairment

NSAIDs, including naproxen and ibuprofen, are contraindicated in severe renal impairment (eGFR below 30 mL/min/1.73m2) as they can cause further deterioration in renal function and fluid retention. The patient should be referred to his GP for alternative management of the acute gout flare, which may include colchicine or a short course of corticosteroids. Co-codamol would not be appropriate for gout.

Reference: BNF; NICE CKS Gout