Abstract
Most anti-inflammatory drugs have been associated with an increased risk of serious upper gastrointestinal complications. Epidemiological studies have estimated the magnitude of the risk for specific anti-inflammatory drugs. The risk of upper gastrointestinal tract bleeding or perforation increases around twofold with use of oral steroids or low dose aspirin, and increases around fourfold with use of nonaspirin nonsteroidal anti-inflammatory drugs. Acetaminophen at daily doses of 2000 mg and higher has also been associated with an increased risk. Overall, the risk is dose dependent and is greater with more than one anti-inflammatory drug taken simultaneously. Hence, whenever possible, anti-inflammatory drugs should be given in monotherapy and at the lowest effective dose in order to reduce the risk of serious upper gastrointestinal complications.
Highlights
Most anti-inflammatory drugs have been associated with gastrointestinal side effects
The corresponding relative risk (RR) value for current users of aspirin and NA-NSAIDs was 8.2, and that for current users of aspirin and high doses of acetaminophen was 3.3 (95% confidence intervals (CI), Relative risk (RR) and 95% confidence interval (CI) of upper gastrointestinal complications associated with combined use of anti-inflammatory drugs
We found a substantial interaction between NA-NSAIDs and high dose acetaminophen; compared with non-users of either drugs, the RR for concurrent users of NA-NSAIDs and acetaminophen (≥ 2 g) was 16.6
Summary
Most anti-inflammatory drugs have been associated with gastrointestinal side effects. Relative risk (RR) and 95% confidence interval (CI) of upper gastrointestinal complications associated with use of steroids, aspirin, nonaspirin nonsteroidal anti-inflammatory drugs (NANSAIDs), and acetaminophen. The RR values in our population, compared with those of non-users of any anti-inflammatory drug, were 8.5 (95% CI, 3.9–18.9) for current users of steroids and NA-NSAIDs, 3.1 (95% CI, 1.2–8.1) for users of steroids and aspirin, and 4.8 (95% CI, 1.1–20.9) for users of steroids and high doses of acetaminophen (≥ 2 g) (the latter two estimates are based on a small number of exposed patients). The corresponding RR value for current users of aspirin and NA-NSAIDs was 8.2 (95% CI, 5.3–12.8), and that for current users of aspirin and high doses of acetaminophen was 3.3 (95% CI, Relative risk (RR) and 95% confidence interval (CI) of upper gastrointestinal complications associated with combined use of anti-inflammatory drugs. Concomitant users of three or four anti-inflammatory drugs (excluding low dose acetaminophen) presented a relative risk of 18.0 (95% CI, 9.0–36.1) compared with persons not exposed to any of the anti-inflammatory drugs (Table 2)
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