ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
NSAID Pregnancy: Avoid in 1st and 2nd trimester unless essential. Contraindicated in 3rd trimester (premature ductus arteriosus closure, pulmonary hypertension, oligohydramnios).

Aceclofenac

Brand names: Preservex

Adult dose

Dose: 100 mg BD
Route: Oral
Frequency: Twice daily
Max: 200 mg/day
Take with food. Use lowest effective dose for shortest duration.

Dose adjustments

Renal

Avoid in eGFR <30 ml/min/1.73m². Caution in mild–moderate impairment — monitor renal function.

Hepatic

Reduce dose; avoid in severe hepatic impairment. Monitor LFTs.

Clinical pearls

  • Cardiovascular risk profile is comparable to diclofenac — avoid in established IHD, cerebrovascular or peripheral vascular disease.
  • Co-prescribe a PPI for patients ≥65 yrs, on anticoagulants/steroids, or with previous GI bleeding.
  • Stop if eGFR drops >25% or creatinine rises >30% from baseline.
  • Naproxen or ibuprofen are preferred where possible — better cardiovascular safety profile.

Contraindications

  • Active or history of peptic ulcer / GI bleeding
  • Severe heart failure (NYHA III–IV)
  • Severe renal impairment (eGFR <30)
  • Severe hepatic impairment
  • Third trimester of pregnancy
  • Asthma / urticaria / allergy precipitated by aspirin or other NSAIDs
  • Coronary artery bypass graft surgery (peri-operative)

Side effects

  • Dyspepsia, abdominal pain, nausea
  • Peptic ulceration and GI bleeding (dose-related)
  • Hypertension, fluid retention, peripheral oedema
  • Renal impairment (especially with ACEi/ARB + diuretic — 'triple whammy')
  • Increased thrombotic risk (MI, stroke) — small but real
  • Hepatotoxicity (raised transaminases)
  • Headache, dizziness

Interactions

  • Anticoagulants (warfarin, DOACs): increased bleeding risk
  • ACEi / ARB + diuretic: 'triple whammy' AKI
  • Lithium: reduced renal clearance — toxicity
  • Methotrexate: reduced clearance — toxicity
  • Other NSAIDs / aspirin: additive GI / renal toxicity
  • SSRIs: additive GI bleeding risk

Monitoring

  • BP at 2–4 weeks then 6-monthly
  • U&Es at 2 weeks then 3–6 monthly
  • FBC and LFTs annually if long-term use

Reference: BNF 90; MHRA Drug Safety Update June 2013 (Diclofenac CV risk — class effect); EMA NSAID Safety Review 2013; NICE CKS NSAIDs. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

Drugs
Pathways