Gastrointestinal adverse effects of NSAIDs

Risk factors for NSAID-induced upper gastrointestinal bleeding or perforation outlines risk factors for gastrointestinal adverse effects with NSAID use. Prevention strategies are discussed here and here.

Avoid NSAIDs in patients with active peptic ulcer disease or gastrointestinal bleeding. For patients with other risk factors for gastrointestinal toxicity, use a COX-2–selective NSAID and a prophylactic proton pump inhibitor (PPI) (see Management of mild intermittent symptoms of gastro-oesophageal reflux in adults for PPI dosing). However, note that the improved gastrointestinal safety profile of COX-2–selective inhibitors is negated by the use of low-dose aspirin.

When using any NSAID for acute pain, limit treatment to 5 days, when possible, to lower the risk of gastrointestinal toxicity.