Risk factors for this complication include older age, multiple NSAID use (e.g., over-the-counter ibuprofen combined with prescription NSAIDs), blood thinners such as Coumadin, corticosteroids, smoking, excessive alcohol use, and prior history of stomach ulcers or gastrointestinal bleeding. In addition, some people may have been exposed to H. pylori, a common bacteria associated with a higher risk of bleeding ulcers.
Fortunately, there are ways to decrease the risk of ulcers and their complications, such as gastrointestinal bleeding. We asked rheumatologist Scott J. Zashin, MD, who suggested these nine ways to decrease the risk of bleeding ulcers from NSAIDs.
There are also topical treatments for localized pain including:
Thermacare patches (moist heat) Ointments such as BenGay Prescription NSAID gels or patches, such as Voltaren gel (diclofenac)
While diclofenac is an NSAID, local application may decrease the level of NSAID in the blood, with a lower risk of bleeding.
Another suggestion for you to consider—with your healthcare provider’s approval—is to take your NSAID as needed, rather than daily. By doing so—and keeping your dose low—you would be reducing the risk of serious side effects.
That said, be sure to take your medication as directed. If you have questions, ask your healthcare provider or pharmacist.
Taking two different NSAIDs is dangerous—it can increase the risk of undesirable side effects and serious adverse events.
There is also data that suggests Celebrex, a COX-2 inhibitor, may have a lower risk of bleeding from the large intestine. Talk to your healthcare provider to see if Celebrex would be a good option for you. It’s worth noting, however, that Celebrex has been tied to heart risks. It’s a balance—weighing risks and benefits.
PPIs include Prilosec (omeprazole) (available over-the-counter), Aciphex (rabeprazole), Prevacid (lansoprazole), Protonix (pantoprazole), and Nexium (esomeprazole). There are also combination products, such as Prevacid NapraPAC that combines naproxen and Prevacid, Duexis (ibuprofen/famotidine), and Vimovo (naproxen/esomeprazole).
Cytotec (misoprostol), a prostaglandin, works differently than PPIs and may decrease the risk of ulcers. Arthrotec (diclofenac/misoprostol), a combination NSAID/prostaglandin, is taken 4 times/day with food to achieve maximum protection, but some protection occurs when taken twice daily.
It is contraindicated in women who are pregnant or could become pregnant because it can cause miscarriage.
Your provider will also regularly check your bloodwork for any signs of bleeding or harm to your kidneys.
By being proactive, it’s possible to catch symptoms early and avoid an emergency situation.
In fact, H. pylori infection is the most common cause of stomach ulcers, and it also results in inflammation of the stomach lining.
Taking NSAIDs on an empty stomach also increases the risk of developing ulcers—even if you are doing it now with no symptoms. The problem may be developing silently. To avoid the possibility, be sure to take NSAIDs with food.
Blood thinners, when taken with NSAIDs, may increase the risk of ulcers or bleeding. Blood thinners include Coumadin (warfarin), Eliquis (apixaban), Xarelto (rivaroxaban), Plavix (clopidogrel), and more.
Talk to your healthcare provider about reducing your risk of developing bleeding ulcers while taking NSAIDs. It’s an important conversation.
