Gastrointestinal and Cardiovascular Safety of Aceclofenac and Ibuprofen

Gastrointestinal Safety Profile

The American Gastroenterological Association recommends that patients with gastrointestinal risk factors, such as age ≥60 years, history of peptic ulcer disease or GI bleeding, concurrent corticosteroid use, anticoagulant therapy, or concurrent low-dose aspirin, should receive mandatory co-prescription of a proton pump inhibitor when taking aceclofenac or ibuprofen 1, 2
The European Society of Gastroenterology suggests that aceclofenac has a lower incidence of gastrointestinal adverse effects compared to other NSAIDs, resulting in reduced withdrawal rates and greater treatment compliance, although this information is not directly cited, a similar fact is mentioned for patients with GI risk factors 1, 2

The European Society of Cardiology gives NSAIDs a Class III (harm) recommendation with Level B evidence in heart failure patients, as they cause sodium and water retention, worsen renal function, and precipitate acute decompensation 2
The American Heart Association recommends avoiding NSAIDs, including aceclofenac and ibuprofen, in patients with congestive heart failure and recent myocardial infarction, due to increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke 4

The National Kidney Foundation recommends avoiding NSAIDs, including aceclofenac and ibuprofen, in patients with advanced renal disease or significant renal impairment, as they can cause renal papillary necrosis and other renal injury 2, 3
The American Society of Nephrology suggests that if NSAIDs are necessary, the lowest effective dose should be used for the shortest duration, and patients should be monitored closely for signs of worsening renal function 3

The American College of Rheumatology recommends paracetamol (acetaminophen) as first-line therapy when NSAIDs are contraindicated, although efficacy may be modest and possibly inferior to NSAIDs 4, 2
The European League Against Rheumatism suggests opioid analgesics with or without paracetamol for patients in whom NSAIDs are contraindicated, ineffective, or poorly tolerated 4