NSAIDs and contraceptives: critical thinking on a harmful drug interaction

Abstract

As an early career doctor I prescribed diclofenac liberally. It was my go-to anti-inflammatory drug for patients in hospital. My prescribing habit wasn’t influenced by evidence but by learnt behaviour. It was the drug others prescribed. Ibuprofen was one of the other options, and during my stint in rheumatology a consultant hadwarnedmeof people taking ibuprofen “like smarties” but being unaware of the risk of renal failure. If not ibuprofen, then diclofenac, or another non-steroidal anti-inflammatory drug. Perhaps the evidencewasn’t then clear about the effects of prescribing NSAIDs to women using hormonal contraception? Perhaps I should have paid more attention? Perhaps I would have been better served by critical appraisal and knowledge synthesis and translation, skills I had barely acquired?