Peptic Ulcers - Treatment

(Page 4)

People with chronic pain may try a number of other medications to minimize the risk of ulcers associated with NSAIDs:

• COX-2 Inhibitors (Coxibs). Coxibs block an inflammation-promoting enzyme called COX-2. This drug class may work as well as NSAIDs and cause less gastrointestinal distress. However, following numerous reports of cardiovascular events with COX-2 inhibitors, only Celecoxib (Celebrex) is still available. (Regular NSAIDs also increase the risk of cardiovascular events.)
• Arthrotec. Arthrotec is a combination of misoprostol and the NSAID diclofenac. It may reduce the risk for gastrointestinal bleeding. This drug can cause miscarriage at any stage of pregnancy and therefore should not be used during pregnancy.
• Acetaminophen. Acetaminophen (Tylenol, Anacin-3) is the most common alternative to NSAIDs. It is inexpensive and generally safe. Acetaminophen poses far less of a gastrointestinal risk than NSAIDs. However, patients who take high doses of acetaminophen for long periods of time are at risk for liver damage, particularly if they drink alcohol. Acetaminophen also may pose a small risk for serious kidney complications in people who already have kidney disease, although it remains the drug of choice for patients with impaired kidney function. Until recently, the recommended maximum daily dose of acetaminophen was 4 grams (4,000 mg), but an FDA advisory panel has recommended lowering the maximum daily dose.
• Tramadol. Tramadol (Ultram) is a pain reliever that has been used as an alternative to opioids. It has opioid-like properties, but is not as addictive. A combination of tramadol and acetaminophen (Ultracet) provides more rapid pain relief than tramadol alone, and more long-term relief than acetaminophen alone. Side effects of tramadol include dependence and abuse, nausea, and itching, but tramadol does not cause the same severe gastrointestinal problems as NSAIDs.
• If patients need to continue taking NSAIDs, they should use the lowest possible dose.

---

---

The American College of Gastroenterology has made recommendations about the prevention of ulcers in patients using NSAIDs. Doctors should consider whether their patients are at high, moderate, or low risk for gastrointestinal and cardiovascular problems. Depending on a patient's risk factors, the doctor may recommend any NSAID, naproxen only, a COX-2 inhibitor, one of these, or none of the three.

Some patients take either a PPI or misoprostol along with their NSAID. Before starting a patient on long-term NSAID therapy, the physician should consider testing for H. pylori.

Click the icon to see an animation on ulcer treatment.

Review Date: 07/18/2011
Reviewed By: Reviewed by: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).