OBJECT DRUGS

NSAIDs:

• Diclofenac (Voltaren, etc.)
• Diflunisal (Dolobid)
• Etodolac (Lodine)
• Fenoprofen (Nalfon)
• Flurbiprofen (Ansaid, etc.)
• Ibuprofen (Motrin, etc.)
• Indomethacin (Indocin, etc.)
• Ketoprofen (Orudis)
• Ketorolac (Toradol, etc.)
• Meclofenamate
• Mefenamic acid
• Meloxicam (Mobic)
• Nabumetone (Relafen)
• Naproxen (Aleve, etc.)
• Oxaprozin (Daypro)
• Piroxicam (Feldene)
• Sulindac (Clinoril)
• Tolmetin (Tolectin)

PRECIPITANT DRUGS

Aldosterone Antagonists:

• Eplerenone (Inspra)
• Spironolactone (Aldactone)

Comment:

The concurrent use of NSAIDs with aldosterone antagonists appears to increase the risk of gastrointestinal (GI) bleeding compared to either drug used alone. Although the vast majority of patients on concurrent therapy with an NSAID and an aldosterone antagonist will not develop GI bleeding, the potential severity of the outcome (including death) suggests that the risk should be avoided if possible.

Class 3: Assess Risk & Take Action if Necessary

• Consider Alternative:
• NSAIDs: If the NSAID is being used as an analgesic, consider using acetaminophen instead. Combining COX-2 inhibitors with aldosterone antagonists may increase the risk of GI bleeding over either drug alone, but the risk is probably less with COX-2 inhibitors + aldosterone antagonists than with NSAIDs + aldosterone antagonists.
• Monitor: Patients and health professionals should be alert for evidence of gastrointestinal bleeding if these combinations are used.