Moderate
Established
Description
Combining ibuprofen with corticosteroids dramatically increases the risk of GI ulcers and hemorrhage beyond the risk of either agent alone.
Mechanism
Ibuprofen impairs prostaglandin-mediated gastroprotection (mucus, bicarb, blood flow); corticosteroids independently impair mucosal defense and healing. The combination is synergistically ulcerogenic.
Clinical Significance
The risk of GI ulceration is increased ~15-fold with combined NSAID + corticosteroid compared with neither drug.
Management
Avoid combination; use acetaminophen for analgesia. If co-administration is essential, prescribe gastroprotective therapy (PPI) and use the lowest effective doses.