GPs have been given conflicting advice on prescribing paracetamol in patients with osteoarthritis, after Scottish medicines experts recommended low doses of the drug could be considered as a first-line option, in direct opposition to recent recommendations from NICE.
The new recommendation comes just a few months after GPs were advised by NICE they should no longer routinely prescribe paracetamol at all for pain relief in osteoarthritis patients, because of concerns over an increased risk of gastrointestinal bleeding.
The SIGN guidance on chronic pain, published this month, also acknowledges emerging evidence of a potential increase in such adverse events with paracetamol, especially in combination with an NSAID.
But rather than ruling it out altogether, SIGN recommends paracetamol 1,000 mg daily can be used either alone or in combination with an NSAID as a first-line analgesic option for hip or knee pain, after non-analgesic approaches on their own have failed.
The guidance states: ‘Paracetamol (1,000 mg/day) should be considered alone or in combination with NSAIDs in the management of pain in patients with hip or knee osteoarthritis in addition to non-pharmacological treatments.’
The SIGN guidance comes after the medicines regulator flatly contradicted NICE saying it has ‘no new evidence’ to support draft guidance released by the institute in August urging GPs not to use paracetamol routinely in osteoarthritis.
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