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J Pain Res. 2018 Feb 14;11:361-374. doi: 10.2147/JPR.S156938. eCollection 2018.

Coprescribing proton-pump inhibitors with nonsteroidal anti-inflammatory drugs: risks versus benefits.

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Stomach, Liver, and Bowel Centre, Gleneagles Hospital.
Department of Pharmacy, National University of Singapore, Singapore.
Global Medical Affairs, Asia-Pacific Region, Pfizer, Hong Kong.
Medical Affairs, Pfizer, Singapore.


Nonsteroidal anti-inflammatory drugs (NSAIDs) are often coadministered with proton-pump inhibitors (PPIs) to reduce NSAID-induced gastrointestinal (GI) adverse events. This coadministration is generally regarded as safe, and is included in many of the guidelines on NSAID prescription. However, recent evidence indicates that the GI risks associated with NSAIDs can be potentiated when they are combined with PPIs. This review discusses the GI effects and complications of NSAIDs and how PPIs may potentiate these effects, options for prevention of GI side effects, and appropriate use of PPIs in combination with NSAIDs.


COX2 inhibitors; NSAIDs; PPIs; enteropathy; gastrointestinal

Conflict of interest statement

Disclosure SS and GL are employees of Pfizer. VG underwent indirect patient-care pharmacy training for 3 months at Pfizer, Singapore. KAG reports no conflicts of interest in this work.

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