GI Bleeding and NSAIDs
Ulcers and GI Bleeding Often Linked to Taking NSAIDs
Next time you have a headache, toothache, or arthritis pain, take a hard look at the label of the NSAID in your medicine cabinet. Chances are you will see a warning about the potential to cause gastrointestinal bleeding, also know as GI bleed or peptic ulcer.
Nonsteroidal anti-inflammatory drugs (NSAIDs) make up one of the most commonly prescribed classes of medications worldwide. But they are not benign medications, especially if you take them frequently.
According to medical studies, there is a 25% chance (risk) that you will develop some type of ulcer while taking the medication. This is especially true in patients who chronically take oral non-selective NSAIDs.
The risk of GI bleeds appears to be highest with ketorolac, and then in decreasing order, piroxicam, indomethacin (Indocin, others), naproxen (Aleve), ketoprofen, meloxicam (Mobic, others), diclofenac (Voltaren, Solaraze, others), and ibuprofen (Advil, Motrin, others). The first 5 NSAIDs are more cyclooxygenase (COX)-1 selective, meloxicam and diclofenac are more COX-2 selective, and ibuprofen is non-selective.
Selecting an NSAID that is more selective to COX-2 may be a safer option if you are at high risk for the gastrointestinal bleeding (ie, have a history of peptic ulcer disease, have had stomach problems before, are taking NSAIDs for more than 1-2 days). However, NSAIDs that are more selective for the COX-2 have been associated with an increased risk in cardiovascular adverse effects, such as heart attacks and stroke. Regardless of selectivity, it has been found that NSAIDs still pose some risk of these side effects.
Additional risk factors for GI bleeding include:
- Older than 60 years of age
- Already taking an anticoagulant, corticosteroids, and/or low-dose aspirin
- Have cardiovascular disease
- Have Helicobacter pylori infection
The tests used to determine if a patient has a H. pylori infection include either a biopsy, or a breath, blood, or stool sample. In patients requiring long-term NSAID therapy, it is sometimes beneficial to undergo testing to determine whether they have the infection. Eradication of the H. pylori infection has been found to be beneficial in preventing ulcers in patients requiring long-term NSAID therapy.
Continuously weighing the benefits versus risks is important, and you should speak with your physician before taking any medications.
Protecting Your Stomach
In you require chronic NSAID therapy but who may have an increased risk for ulcers, you can take protective measures. The most common agents available for prevention of NSAID-related GI ulcers include misoprostol (Cytotec, others), histamine 2 receptor antagonists (H2RAs), and proton pump inhibitors (PPIs). If a preventive therapy is required, misoprostol and PPIs have been found to be more effective than H2RAs.
Common examples of OTC preparations of H2RAs include cimetidine (Tagamet, others), famotidine (Pepcid, others), and ranitidine (Zantac, others). Examples of PPIs include omeprazole (Prilosec, others), esomeprazole (Nexium, others), lansoprazole (Prevacid, others), dexlansopraxole (Dexilant), pantoprazole (Protonix, others), and rabeprazole (Aciphex).
Always consult your physician before taking any new medication, especially if you have one of the risk factors mentioned above.