Table 2 |
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Clinicians' guide to anti-inflammatory therapy (reproduced from reference [15], with permission) |
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No or low NSAID gastrointestinal risk |
NSAID gastrointestinal risk |
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|
|
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No cardiovascular risk (without aspirin) |
Nonselective NSAID (cost consideration) |
COX-2 selective inhibitor or nonselective NSAID and proton-pump inhibitor |
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COX-2 selective inhibitor and proton-pump inhibitor for those with prior GI bleeding |
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Cardiovascular risk (with aspirin) |
Naproxena |
Proton-pump inhibitor irrespective of NSAID |
|
Addition of proton-pump inhibitor if gastrointestinal risk of aspirin/NSAID combination warrants gastroprotection |
Naproxen if CV risk outweighs GI risk |
|
|
COX-2 selective inhibitor and proton-pump inhibitor for those with previous GI bleeding |
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|
|
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COX = cyclooxygenase; CV = cardiovascular; GI = gastrointestinal; NSAID = nonsteroidal anti-inflammatory drug. aNonselective or selective (low-dose) inhibitor without established aspirin interaction if naproxen is ineffective. Misoprostol at full dose (200 μg four times a day) may be substituted for proton-pump inhibitor. |
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Fendrick et al. Osteopathic Medicine and Primary Care 2008 2:2 doi:10.1186/1750-4732-2-2 |
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