Gout - Medications

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 and the rate of NSAID-caused ulcers in increasing. Ulcers caused by nonsteroidal anti-inflammatory drugs (NSAIDs) are more likely to bleed than those caused by the bacteria H. pylori. NSAID-related bleeding and stomach problems may be responsible for 107,000 hospital admissions and 16,500 deaths each year. Because there are usually no gastrointestinal symptoms from NSAIDs until bleeding begins, physicians cannot predict which patients taking these drugs will develop bleeding. Among the groups at high risk for bleeding are elderly people, anyone with a history of ulcers or GI bleeding, patients with serious heart conditions, alcohol abusers, and those on certain medications, such anticoagulants ("blood thinners"), corticosteroids, or bisphosphonates (drugs used for osteoporosis).

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 agent called misoprostol and the NSAID diclofenac that may reduce the risk for gastrointestinal bleeding. One study found that patients taking Arthrotec had 65 -80% fewer ulcers than those who took NSAIDs alone.
In addition, agents are available that may help prevent ulcers in people who need to take NSAIDs. For example, proton-pump inhibitors (PPIs) 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.

Other Investigative Alternatives to NSAIDs

NO-NSAIDs. Experimental agents are being developed that combine nitric oxide (NO) with NSAIDs. These treatments are called NO-NSAIDs. NO increases blood flow in the mucous lining and secretions of mucus and bicarbonate. Combining nitric oxide with NSAIDs may reduce the adverse effects on the GI tract. In addition, according to one study, an experimental NO-aspirin also had the heart protective properties of aspirin without its gastrointestinal problems. (COX-2 inhibitors may have adverse effects on the heart.)