Avoiding Stomach Problems with NSAIDs

How to Reduce Your Risk

At some point in the course of arthritis treatment, virtually everyone takes a nonsteroidal anti-inflammatory drug (NSAID). These plentiful and often inexpensive drugs can work wonders at relieving pain and inflammation. Unfortunately, there can be a downside to such medication: stomach upset and bleeding ulcers.

Celecoxib (Celebrex) is a part of a class of NSAIDs called COX-2 inhibitors that has been promoted for the ability to ease pain and inflammation while causing less gastrointestinal damage than traditional NSAIDs do. But a COX-2 drug isn't your only drug option if NSAIDs bother your stomach. In some cases, taking an acid-blocking drug along with your regular NSAID may help. These drugs include histamine blockers such as cimetidine (Tagamet) and ranitidine hydrochloride (Zantac), or proton pump inhibitors such as lansoprazole (Prevacid) and omeprazole (Prilosec). In other cases, doctors may prescribe a drug called misoprostol (Cytotec) along with your NSAID.

Misoprostol reduces the risk of stomach ulcers and promotes healing of existing ulcers by replacing stomach-protective substances called prostaglandins, which NSAIDs block. Misoprostol may also be taken as part of a combination product called Arthrotec, which contains both misoprostol and the NSAID diclofenac sodium. Another combination is Prevacid NapraPac, which packages Prevacid and naproxen together. In still other cases, no special medication is necessary. If your doctor recommends it and you can just reduce the dosage of your current NSAID, stomach problems may become manageable.

Regardless of the medication option you and your doctor choose, there are some things you can do on your own to minimize the risk of NSAID-related stomach upset and other problems. The following tips may help:

• Skip alcohol. You increase your risk of gastric bleeding if you consume alcohol while you're taking an NSAID.  
• Take with food and water. Unless the product label or your doctor advises otherwise, always take medications with a full glass of water and some food ­even if it's just a few crackers. Taking your NSAID along with an antacid/calcium supplement may also help, but first speak with your doctor.  
• List your medications. Keep a list of all the medications you take, updating your list as necessary and sharing it with your doctor and pharmacist whenever you start a new medication. Taking some medications together can increase your risk of side effects. For example, taking corticosteroids and blood thinners such as warfarin (Coumadin) along with NSAIDs can increase your risk of gastrointestinal bleeding.  
• Check the clock. If you take an NSAID once a day, ask your doctor if it's OK to take your daily dose in the afternoon or evening. Taking an NSAID later in the day may be less likely to lead to stomach upset and other side effects than taking the same drug in the morning.  
• Don't overdo it. Avoid the temptation to take more NSAIDs than prescribed or more often than prescribed. If your current dose of NSAID doesn't sufficiently relieve pain and inflammation, speak to your doctor about increasing your dose or perhaps changing medications. You also risk overdose and increase your risk of stomach ulcers and other side effects if you take your prescription NSAID and then unwittingly take another medication, such as a cold remedy from the drugstore shelf that contains an NSAID.