Medical Health Encyclopedia

Ulcer Risk for Specific NSAIDs. One study ranked the sixteen most commonly used NSAIDs according to risk for ulcers and bleeding.

• Lowest Risk: Nabumetone (Relafen), etodolac (Lodine), salsalate, and sulindac (Clinoril).
• Medium Risk: Diclofenac (Voltaren), ibuprofen (Motrin, Advil, Nuprin, Rufen), aspirin, naproxen (Aleve, Naprosyn, Naprelan, Anaprox), and tolmetin (Tolectin). Drugs within this group vary in risk. Studies show, for example, that short-term use of naproxen is twice as likely as ibuprofen to be associated with hospitalization from GI bleeding. Although ketoprofen (Actron, Orudis KT) was considered a medium-risk drug, another study reported that even one week of taking the drug at low doses causes significant GI injury.
• Highest Risk: Flurbiprofen (Ansaid), piroxicam (Feldene), fenoprofen, indomethacin (Indocin), meclofenamate (Meclomen), and oxaprozin.

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Drugs for Prevention NSAID-Induced Ulcers. If NSAID-induced ulcers are identified, the following steps have been suggested:

• Switching to alternative pain relievers is the first step in preventing or healing ulcers caused by NSAIDs. If people cannot change drugs, then they should used the lowest NSAID dose possible. For example, Arthrotec is a combination of an ulcer protective drug called misoprostol and the NSAID diclofenac that may reduce the risk for gastrointestinal bleeding. One study found that patients taking Arthrotec had 65% to 80% fewer ulcers than those who took NSAIDs alone.
• Adding on proton-pump inhibitors (PPIs). These drugs are the first choice for preventing ulcers in high-risk individuals and have been demonstrated to reduce NSAID-ulcer rates by as much as 80% compared with no treatment. Brands include omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid), rabeprazole (Aciphex), and pantoprozole (Protonix). Prevacid is the first proton-pump inhibitor to be specifically indicated for protecting against ulcers in chronic NSAID users.