Systemic Lupus Erythematosus - Treatment for Cutaneous and Mild SLE

Diabetics taking oral hypoglycemics may need to adjust the dosage if they also need to take NSAIDs because of possible harmful interactions between the drugs.

Note: Some studies have reported that ibuprofen (but not other NSAIDs) may blunt the heart-protective effects of low-dose aspirin, Additional research is needed to confirm these findings.

NSAID-Induced Ulcers and Gastrointestinal Bleeding

Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) is the second most common cause of ulcers. Ulcers caused by nonsteroidal anti-inflammatory drugs (NSAIDs) are more likely to bleed than those caused by the bacteria Heliobacter pylori.

NSAID-related bleeding and stomach problems may be responsible for 107,000 hospital admissions and 16,500 deaths each year.Those at high risk for bleeding include theelderly, anyone with a history of ulcers of gastointestinal bleeding, patients with serious heart conditions, people who abuse alcohol, and those on medications such anticoagulants (blood thinners), corticosteroids, or bisphosphonates (drugs used for osteoporosis).

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.

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.