From the Guidelines
The most effective combination pill for patients requiring both a Non-Steroidal Anti-Inflammatory Drug (NSAID) and a Proton Pump Inhibitor (PPI) is Vimovo (naproxen/esomeprazole), as it combines the anti-inflammatory effects of naproxen with the gastroprotective effects of esomeprazole, reducing the risk of gastrointestinal complications. The main options for combination pills include Vimovo (naproxen/esomeprazole), Duexis (ibuprofen/famotidine), and Arthrotec (diclofenac/misoprostol) 1. Vimovo combines naproxen (375 or 500 mg) with esomeprazole (20 mg) and is typically taken twice daily. Duexis contains ibuprofen (800 mg) and famotidine (26.6 mg), also taken three times daily. Arthrotec pairs diclofenac (50 or 75 mg) with misoprostol (200 mcg), usually taken two to three times daily. These combination medications are particularly beneficial for patients with a history of gastric ulcers, those on long-term NSAID therapy, elderly patients, or those taking medications that increase bleeding risk like anticoagulants, as supported by studies such as 1 and 1. The PPI component reduces gastric acid production, protecting the stomach lining from NSAID-induced damage, while the NSAID provides pain relief and reduces inflammation. It's worth noting that these combination products are often more expensive than taking the components separately, and insurance coverage may be limited. Patients should be aware that despite the gastroprotective component, these medications still carry other NSAID risks including cardiovascular concerns and kidney effects, as highlighted in studies 1. In patients with previous ulcer bleeding who require an NSAID, the combination of a PPI and a COX-2 inhibitor is recommended to reduce the risk for recurrent bleeding from that of COX-2 inhibitors alone, as stated in 1. Population-based studies also support adding a PPI to traditional NSAID therapy or administering a COX-2 inhibitor to reduce the risk for upper gastrointestinal complications; however, the combination of a COX-2 inhibitor with a PPI was associated with the greatest risk reduction, as seen in 1 and 1. One RCT demonstrated a significantly lower rate of recurrent UGIB with a COX-2 inhibitor plus a PPI (0%) compared with a COX-2 inhibitor alone (8.9%) over 1 year, as reported in 1. Several studies have also shown lower risks for endoscopic ulcers in patients who receive a COX-2 inhibitor plus a PPI compared with those who receive a COX-2 inhibitor alone, as mentioned in 1 and 1. Therefore, Vimovo (naproxen/esomeprazole) is the recommended combination pill for patients requiring both an NSAID and a PPI, due to its efficacy in reducing gastrointestinal complications and its convenience of use.
From the FDA Drug Label
NSAID medicines that need a prescription Generic Name Trade Name ... Naproxen Naprosyn®, Anaprox®, Anaprox® DS, EC-Naproxyn®, Naprelan®, Naprapac® (copackaged with lansoprazole)
The combination pill option for a Non-Steroidal Anti-Inflammatory Drug (NSAID) and a Proton Pump Inhibitor (PPI) is Naprapac, which is copackaged with naproxen (NSAID) and lansoprazole (PPI) 2.
From the Research
NSAID and PPI Combination Pill Options
The combination of a Non-Steroidal Anti-Inflammatory Drug (NSAID) and a Proton Pump Inhibitor (PPI) is a common strategy for reducing the risk of upper gastrointestinal (GI) complications in long-term users of NSAIDs. The following are some options for combination pill:
- Celecoxib and PPI: The combination of celecoxib, a COX-2 inhibitor, with a PPI has been shown to be effective in reducing the risk of upper GI complications 3.
- Nonselective NSAID and PPI: The use of a nonselective NSAID with a PPI has been found to be at least as effective as the use of a COX-2 selective inhibitor in preventing the recurrence of ulcer complications 4.
- COX-2 inhibitor and PPI: The combination of a COX-2 inhibitor with a PPI may be appropriate for patients with a high GI risk and a moderate CV risk 4.
Key Considerations
When considering a combination pill of an NSAID and a PPI, the following factors should be taken into account:
- GI risk factors: Patients with a history of peptic ulcer, older age, or other GI risk factors may require a combination pill with a PPI 3, 5.
- CV risk factors: Patients with established CV disease or an estimated 10-year CV risk >20% may require a combination pill with a COX-2 inhibitor and a PPI 4.
- Concurrent aspirin use: Patients taking aspirin may require a combination pill with a PPI to reduce the risk of GI complications 6, 7.
- Helicobacter pylori infection: Patients with H. pylori infection may require testing and treatment before initiating NSAID therapy 7.
Available Combination Pills
Some examples of available combination pills include: