OBJECT DRUGS

NSAIDs or Aspirin:

• 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

Corticosteroids:

• Cortisone (Cortone)
• Dexamethasone (Decadron, etc.)
• Hydrocortisone (Cortef, etc.)
• Methylprednisolone (Medrol, etc.)
• Prednisolone (Orapred, etc.)
• Prednisone
• Triamcinolone (Aristocort, etc.)

Comment:

The concurrent use of NSAIDs or aspirin (even low dose aspirin) with systemic corticosteroids appears to increase the risk of gastrointestinal (GI) bleeding compared to either drug used alone. In one study the risk appeared to be synergistic rather than additive. Although the vast majority of patients on concurrent therapy with an NSAID or aspirin with corticosteroids 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 corticosteroids may increase the risk of GI bleeding over either drug alone, but the risk is probably less with COX-2 inhibitors + corticosteroids than with NSAIDs + corticosteroids.
• Monitor: Patients and health professionals should be alert for evidence of gastrointestinal bleeding if these combinations are used.