Nonsteroidal anti-inflammatory drugs (NSAIDs) may be associated with serious gastrointestinal toxicity. Since NSAIDs are one of the most commonly medications, especially in over-the-counter preparations, the total number of patients showing evidence of gastrointestinal toxicity is very large. Certain risk factors increase the likelihood of these adverse events.


Gastrointestinal toxicities associated with NSAIDs:

(1) dyspepsia

(2) ulcer or perforation

(3) GI bleeding


Risk factors for serious gastrointestinal toxicity in patients taking NSAIDs:

(1) advanced age (linear increase in risk)

(2) high doses of NSAIDs, including the use of more than 1 NSAID

(3) shorter duration of therapy

(4) history of peptic ulcer disease or of gastrointestinal bleeding

(5) serious systemic disorder

(6) concomitant corticosteroid use

(7) concomitant anticoagulant therapy


Patients with risk factors for gastrointestinal toxicity may benefit from:

(1) use of a reduced dose

(2) closer monitoring

(3) patient education on warning signs

(4) use of medications to protect the gastrointestinal mucosa such as proton-pump inhibitors


Notes on spreadsheet implementation:

(1) Age >= 75 is scored 2, >= 65 is scored 1, else 0.

(2) A total dose that is very high is scored 2, high is scored 1, else 0.

(3) Comorbid conditions: 1 or more serious is scored 1, 2 or more moderate conditions are scored 1, else 0.


To read more or access our algorithms and calculators, please log in or register.