List five risk factors for NSAID-induced ulceration. How can this risk be minimized?
- Advanced age (particularly over 60)
- Past history of GI ulceration or hemorrhage
- Higher NSAID doses
- Concurrent anticoagulant use
- Concurrent corticosteroid use
- Use of multiple NSAIDs
- Alcohol use
To minimize the risk of NSAID-induced mucosal injury, alternative analgesics (such as acetaminophen) should be used when possible. When using NSAIDs, use the lowest effective dose.
COX-2 selective agents reduce the likelihood of gastric complications by approximately 50%, relative to non-selective agents.
Misoprostol or a PPI can be used with non-selective NSAIDs to reduce the likelihood of GI ulceration and bleeding.