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NSAID Gastrointestinal Adverse Effects
- See Also
- NSAID
- NSAID Alternatives
- Risk factors for NSAID related GI adverse effects
- Age over 60 years (decreased GI protection)
- Peptic Ulcer Disease history
- Concurrent Corticosteroid use
- Concurrent oral Anticoagulation (Coumadin, Aspirin)
- High dose NSAID
- Relative Risks of GI adverse effects
- Lowest Risk: COX2 Inhibitors (Selective)
- Celecoxib (Celebrex)
- Rofecoxib (Vioxx)
- Low Risk (Non-Selective NSAIDs)
- Ibuprofen 1.0
- Fenoprofen (Nalfon) 1.6
- Aspirin 1.6
- Diclofenac (Voltaren) 1.8
- Sulindac (Clinoril) 2.1
- Nabumetone (Relafen)
- Etodolac (Lodine)
- Salsalate
- Medium Risk
- Diflunisal (Dolobid) 2.2
- Naproxen (Naprosyn) 2.2
- Indomethacin (Indocin) 2.4
- Tolmetin (Tolectin) 3.0
- High Risk
- Piroxicam (Feldene) 3.8
- Ketoprofen (Orudis) 4.2
- Azapropazone 9.2
- Flurbiprofen (Ansaid)
- Gastroduodenal Ulcer Incidence by endoscopy (12 weeks)
- Naprosyn: 35%
- Ibuprofen: 23-29% (2 different trials)
- Diclofenac: 10%
- Rofecoxib: 5-8% (25-50 mg)
- Celecoxib: 7%
- Placebo: 4-7% (2 different trials)
- References
- (1999) Med Lett Drugs Ther 41(1045):11
- Laine (1999) Gastroenterology 116:A229
- Prophylaxis
- General
- Always use NSAID with food or milk
- COX2 Inhibitors have no advantage over standard NSAID
- Consider screening for Helicobacter Pylori before use
- Indications for prophylaxis (avoid NSAIDs if possible)
- Age over 75 years
- Concurrent Warfarin therapy
- History of Peptic Ulcer Disease
- History of Gastrointestinal Bleeding
- History of Coronary Artery Disease
- Misoprostol (Cytotec)
- Dose: 100-200 ug tid to qid
- Replaces prostaglandins at stomach lining
- Allows use of NSAIDS in Peptic Ulcer Disease
- Causes significant dose limiting Diarrhea
- Sucralfate
- Ineffective at preventing NSAID related Peptic Ulcers
- H2 Receptor Antagonists (e.g. Zantac, Tagamet)
- Not recommended (may mask GI symptoms)
- Prevents Duodenal Ulcer, not Gastric Ulcer
- Consider high dose H2 Antagonist
- Omeprazole
- Heals, but may not protect from formation
- References
- Henry (1996) BMJ 312:1563
- (1999) Med Lett Drugs Ther 41(1045):11
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