TABLE 6.

The use of nonsteroidal anti-inflammatory drugs (NSAIDs) in relation to gastrointestinal (GI) safety

Patients at low risk for GI complications (ie, <65 years of age with no risk factors for upper GI complications)* Nonselective NSAIDs are appropriate

Patients >65 years or any patient with a suspected history of ulcer* Test for Helicobacter pylori and eradicate if positive before using an NSAID

In elderly patients without cardiovascular risks* COX-2 selective agent preferred†

Patients with GI risk factors on low-dose ASA who require a NSAID* Treat with a proton pump inhibitor for gastroprotection Note the combination of a COX-2 selective agent with ASA carries risks of GI complications similar to nonselective NSAIDs alone

Ulcer‡ Discontinue NSAID and switch to acetaminophen or nonacetylated salicylate If NSAID must be continued, use a proton pump inhibitor concurrently until ulcer is healed

Prophylaxis after ulcer heals‡ Misoprostol (prostaglandin E1 analogue) Proton pump inhibitor

^*From reference 27;

^†Caution should be used;

^‡From reference 32. ASA Acetylsalicylic acid; COX-2 Cyclo-oxygenase-2