Current evidence suggests that
NSAIDs increase the risk of lower GI bleeding and perforation
to a similar extent as that seen in the upper GI tract. Selective COX-2 inhibitors are as effective as traditional NSAIDs to relieve inflammation.
Why do NSAIDs increase risk of bleeding?
Aspirin and nonaspirin nonsteroidal antiinflammatory drugs (NSAIDs) inhibit platelet cyclooxygenase, thereby blocking the formation of thromboxane A2. These drugs produce a
systemic bleeding tendency by impairing thromboxane-dependent platelet aggregation and consequently prolonging the bleeding
time.
How does NSAIDs cause gastrointestinal bleeding?
By blocking the Cox-1 enzyme and disrupting the production of prostaglandins in the stomach
, NSAIDs can cause ulcers and bleeding. Some NSAIDs have less effect on prostaglandins in the stomach than others, and, therefore, may have a lower risk of causing ulcers, but the increased risk of ulcers still exists.
How do NSAIDs affect the GI tract?
NSAIDs injure the GI tract by
causing topical injury to the mucosa
and by systemic effects associated with mucosal prostanoid depletion derived from COX inhibition. The main clinically relevant GI side effects include GI bleeding, perforation and obstruction.
Factors such as older age (greater than or equal to 60 years),
a history of peptic ulcer disease, concomitant corticosterid use, cigarette smoking, alcohol use, and high dose or multiple NSAID therapy
can increase the risk of GI damage and complications in the chronic NSAID user.
Which Nsaid is easiest on stomach?
Studies have found that
ibuprofen and meloxicam
may be less likely to bother your stomach, while ketorolac, aspirin, and indomethacin are associated with a higher risk of GI problems.
Which NSAIDs can most often cause gastrointestinal bleeding?
The risk of GI bleeds appears to be highest with
ketorolac
, and then in decreasing order, piroxicam, indomethacin (Indocin, others), naproxen (Aleve), ketoprofen, meloxicam (Mobic, others), diclofenac (Voltaren, Solaraze, others), and ibuprofen (Advil, Motrin, others).
Which Nsaid is least likely to cause bleeding?
NSAIDs with short half-life and used at low daily dose, such as
ibuprofen
, have a smaller risk of upper GI bleeding, Dr. Rodríguez said.
Do all NSAIDs cause bleeding?
All
NSAIDs increase both bleeding and cardiovascular disease
(CVD) risk but selective COX-2 inhibitors are more likely to cause cardiovascular events, whereas less selective NSAIDs are more likely to cause GI bleeds.
What is the strongest Nsaid?
“We provide sound evidence that
diclofenac 150 mg/day
is the most effective NSAID available at present, in terms of improving both pain and function,” writes Dr da Costa.
What is the least harmful Nsaid?
Compared with
naproxen
, the least harmful NSAID for cardiovascular outcomes, valdecoxib was associated with the highest risk of stroke (adjusted HR 1.41, 95% CI 1.04, 1.91).
What can I take to protect my stomach from NSAIDs?
Take NSAIDs at the end of a full meal or with an antacid
Drugs that reduce stomach irritation include
misoprostol (Cytotec)
, or a proton pump inhibitor such as omeprazole (Prilosec), esomeprazole (Nexium), pantoprazole (Protonix), lansoprazole (Prevacid), or rabeprazole (Aciphex).
Which Nsaid causes the most GI side effects?
In data from the RCTs,
indomethacin
more than doubled the risk for GI complications, and substantial increased risk was also associated with the other NSAIDs.
How ibuprofen causes stomach ulcers?
NSAIDs can cause
ulcers by interfering with the stomach’s ability to protect itself from gastric acids
. 2 While these acids are vital to the digestive process, they can cause damage if the protective barriers of the stomach are compromised.
Can NSAIDs cause duodenal ulcers?
NSAIDs may be associated with many gastrointestinal problems, ranging from mild to severe dyspeptic symptoms, the development of gastric or duodenal ulceration, haemorrhage or perforation, and other events which may lead to hospitalisation or death.
Can ibuprofen give you blood clots?
24, 2014 (HealthDay News) — People who use painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs) — which include aspirin, naproxen (Aleve) and ibuprofen (Advil, Motrin) —
may be at increased risk for potentially deadly blood clots
, a new study suggests.
