REVIEW - Appropriate use of PPIs with NSAIDs and COX-2 selective inhibitors

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Alimentary Pharmacology & Therapeutics

Volume 19 Issue s1 Page 60 - February 2004

Review Article

Appropriate use of proton pump inhibitors with traditional

nonsteroidal anti-inflammatory drugs and COX-2 selective inhibitors

Summary

Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most

commonly used classes of medications in the USA, annually accounting for

over 100 million prescriptions. Gastrointestinal complications

associated with NSAIDs are common, and result in a substantial amount of

morbidity and mortality, despite the advent of the cyclooxygenase-2

selective inhibitors or 'coxibs'. Emerging clinical and economic data

suggest that, depending on the baseline risk to patients, the use of a

traditional NSAID alone or in combination with a proton pump inhibitor

are effective and well tolerated alternatives to coxibs. The optimal

therapeutic strategy for NSAID selection and use of co-therapy should be

guided by a consideration of each patient's risk of having an adverse

event arising from the NSAID. Patients at the highest risk for

gastrointestinal complications with traditional NSAIDs are those with a

history of an ulcer or ulcer complication, those of advanced age

(greater than 65 years), and those receiving concurrent aspirin,

anticoagulants or corticosteroid therapy. Proton pump inhibitor

co-therapy is highly effective in reducing NSAID-related dyspeptic

symptoms, healing the injured mucosa even in those who continue to

ingest NSAIDs, and preventing gastrointestinal complications. In

addition to their selective use in patients who experience NSAID-related

dyspepsia and other symptoms, proton pump inhibitor co-therapy should be

considered in those at high risk (with coxib or traditional NSAID

therapy) and is necessary in high-risk patients receiving aspirin, with

or without NSAID therapy.

http://www.blackwell-synergy.com/links/doi/10.1111/j.0953-0673.2004.01840.x/abs/

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Mayo Clinic in Rochester

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s Hopkins Medicine

http://www.hopkinsmedicine.org