Combined use of nonselective nonsteroidal anti-inflammatory drugs (nNSAIDs), COX-2 selective inhibitors, or low-dose aspirin with selective serotonin reuptake inhibitors significantly increases the risk of upper gastrointestinal (GI) bleeding, researchers report in the October issue of Gastroenterology.
In their case series analysis of data from 114,835 patients with upper GI bleeding (930,888 person-years of follow-up), Gwen M.C. Masclee et al. also found that concomitant use of nNSAIDs or low-dose aspirin, but not COX-2 inhibitors, with corticosteroids, aldosterone antagonists, or anticoagulants produced significant excess risk of upper GI bleeding (see video):
Masclee says that the findings from their study should alert physicians to the need to select appropriate pain control therapy while balancing the risks associated concomitant drug use, in order to minimize upper GI bleeding.
She says the results are especially applicable to the elderly, who are likely to be treated with multiple drugs.