From the Guidelines
Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most common cause of gastric irritation, and management strategies should focus on reducing stomach acid production, protecting the gastric mucosa, or avoiding prostaglandin inhibition. The most common culprits of gastric irritation are NSAIDs, including ibuprofen (Advil, Motrin), naproxen (Aleve), aspirin, diclofenac, and indomethacin, as well as other medications like corticosteroids, certain antibiotics, bisphosphonates, potassium supplements, and some chemotherapy agents 1.
Management Strategies
To manage drug-induced gastric irritation, the following strategies can be employed:
- Take medications with food or milk unless contraindicated
- Avoid alcohol and smoking
- Use the lowest effective dose for the shortest duration possible
- Add protective medications, such as:
- Proton pump inhibitors (omeprazole 20mg daily, esomeprazole 40mg daily)
- H2 blockers (famotidine 20mg twice daily)
- Mucosal protectants (sucralfate 1g four times daily) For NSAIDs specifically, consider COX-2 selective options like celecoxib (Celebrex) which cause less gastric irritation, or discuss with your doctor about switching to alternative pain relievers like acetaminophen 1.
High-Risk Patients
In high-risk patients (elderly, history of ulcers, concurrent anticoagulants), prophylactic acid-suppressing therapy should be started simultaneously with the irritating medication 1.
Additional Considerations
The presence of H. pylori infection increases the risk of upper gastrointestinal complications in NSAID users, suggesting that all patients requiring regular NSAID therapy be tested for H. pylori 1. Misoprostol has been shown to be effective in reducing NSAID-related gastroduodenal ulcers, although side effects like abdominal cramps and diarrhea are common 1.
From the FDA Drug Label
In clinical studies in patients with rheumatoid arthritis and osteoarthritis, ibuprofen tablets have been shown to be comparable to aspirin in controlling pain and inflammation and to be associated with a statistically significant reduction in the milder gastrointestinal side effects [see ADVERSE REACTIONS] Gastroscopic studies at varying doses show an increased tendency toward gastric irritation at higher doses. However, at comparable doses, gastric irritation is approximately half that seen with aspirin
The group of drugs that causes gastric irritation is NSAIDs (Nonsteroidal Anti-Inflammatory Drugs), such as ibuprofen and aspirin. To manage gastric irritation, patients should be carefully followed for signs and symptoms of gastrointestinal ulceration and bleeding. Key points to manage gastric irritation include:
- Careful monitoring of patients for gastrointestinal side effects
- Using the lowest effective dose of NSAIDs
- Avoiding concomitant use of other NSAIDs or aspirin 2
From the Research
Group of Drugs Causing Gastric Irritation
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are a broad class of non glucocorticoid drugs that can cause gastric irritation, including ulcers, bleeding, and perforation 3, 4, 5.
- The main concern limiting the use of NSAIDs is their gastrointestinal (GI) toxicity, which can lead to serious complications such as upper GI bleeding and development of upper GI symptoms like dyspepsia 3.
Management of Gastric Irritation
- Proton pump inhibitor (PPI) therapy can decrease the development of NSAID-associated ulcers and recurrent NSAID-related ulcer complications, and also decrease upper GI symptoms in NSAID users 3, 6.
- Histamine-2 receptor antagonists can reduce the risk of NSAID-induced duodenal injury, but their therapeutic effect on NSAID-induced gastric ulcers remains to be further confirmed 4.
- Gastric mucosal protective agents, such as misoprostol, can also be used to prevent NSAID-induced GI injury, but their use is limited due to issues of compliance and side effects 3, 7.
- Selective cyclooxygenase-2 (COX-2) inhibitors can be used as an alternative to non-selective NSAIDs, but their use should be cautious due to concerns regarding cardiovascular toxicity 4, 5, 7.
- The risk of GI ulcers and complications caused by NSAIDs can be reduced by assessing the risk factors, using the lowest dose and shortest duration of the NSAID, and concomitantly using PPIs, misoprostol, or histamine-2 receptor antagonists 4, 7.