Table 2 SPPiRE PIP; drug groups frequently implicated in preventable drug related morbidity [34]

NSAIDS

With diuretic and ACEi/ARB [33]

Risk of renal impairment

With chronic kidney disease (eGFR <50 ml/min/ 1.73m²) [15, 33]

For ≥12 weeks with no gastroprotection [33]

Risk of GI bleed

With a history of PUD with no gastroprotection [15]

and antiplatelet with no gastroprotection [15]

With an anticoagulant [15, 35]

With severe hypertension or heart failure [15]

Risk of hypertension/heart failure exacerbation

COX-2 selective with concurrent cardiovascular disease [15]

Increased risk of MI/CVA

Antiplatelets

And history of PUD with no gastroprotection [33, 35]

Risk of GI bleed

And anticoagulant with no gastroprotection [33, 35]

Aspirin and clopidogrel with no gastroprotection [33]

Consider intended duration of treatment if taking dual anti-platelet therapy for over 1 year post PCI [15]

Not usually indicated

Anticoagulants

For first uncomplicated DVT for >6 months duration [15]

Not indicated

For first uncomplicated PE for >12 months duration [15]

Dabigatran if eGFR <30 ml/min/1.73m² or if renal function is unknown [15]

Risk of bleeding

Rivaroxaban or apixaban if eGFR <15 ml/min/1.73m² or if renal function is unknown [15]

Diuretics

And no renal profile in the last 48 weeks [33]

Risk of renal impairment and electrolyte abnormality

Loop diuretic and thiazide diuretic and no renal profile in the last 24 weeks [33]

Loop diuretic for dependent oedema and no heart failure, liver failure or nephrotic syndrome [15]

Risks usually out weigh benefits

Thiazide diuretic with a history of gout [15]

Risk of precipitating gout