Principles for the use of non-steroidal anti-inflammatory drugs with proton pump inhibitors

Abstract

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used in numerous areas of medicine. By inhibiting theprostaglandin synthesis pathway, they contribute to the development of injuries to the mucous membranes within thegastrointestinal tract, possibly leading to gastrointestinal bleeding. Proton pump inhibitors (PPIs) are used to preventsuch events in high-risk groups. The bleeding risk is highest in patients above the age of 65, patients with a history ofgastrointestinal bleeding, and patients with a history of peptic ulcer disease. The efficacy of bleeding prevention could not beproven in other groups. Notably, PPIs are associated with serious side effects, including acute kidney injury, malabsorptionsyndrome, and osteoporosis. Therefore, recommending the use of PPIs within the framework of prevention should beapproached with caution. The widespread belief that IPP should be automatically prescribed together with NSAIDs is falseand harmful to patients.