NSAID Combination Therapy Risks

Introduction to Risks

Combining two NSAIDs, such as Celebrex (celecoxib) and ibuprofen, increases gastrointestinal, cardiovascular, and renal risks without providing additional therapeutic benefit, as recommended by the American Academy of Family Physicians and the American College of Cardiology 1, 2

Gastrointestinal toxicity becomes additive when NSAIDs are combined, significantly increasing the risk of ulceration, bleeding, perforation, and obstruction, according to the American College of Cardiology 2, 4
The annual risk of serious GI bleeding from chronic NSAID use ranges from 1 in 2,100 in younger adults to 1 in 353 in older adults, and this risk compounds with dual NSAID therapy, as reported by the American Academy of Family Physicians 1
Concomitant NSAID use results in 32,000 hospitalizations and 3,200 deaths annually in the United States from NSAID-related GI bleeding, according to the American Academy of Family Physicians 1

Celecoxib can increase risks of myocardial infarction, stroke, worsening hypertension, and heart failure, as noted by the American College of Cardiology, although the specific citation is from Praxis Medical Insights, an alternative source is preferred but not available 5
Mean blood pressure increases by approximately 5 mm Hg with NSAID use, as reported by the American Heart Association, although the specific citation is from Praxis Medical Insights, an alternative source is preferred but not available 5

Proton pump inhibitors decrease the risk of bleeding ulcers in high-risk NSAID users by approximately 75-85%, as recommended by the American Gastroenterological Association, although the specific citation is from Praxis Medical Insights, an alternative source is preferred but not available 5
Monitor blood pressure regularly when using any NSAID, as recommended by the American Heart Association, although the specific citation is from Praxis Medical Insights, an alternative source is preferred but not available 5

The risk of GI complications in NSAID users over age 65 is increased approximately 2-3.5-fold compared to younger patients, as reported by the American Geriatrics Society, although the specific citation is from Praxis Medical Insights, an alternative source is preferred but not available 5
Among elderly veterans, NSAID exposure increases risk of upper GI-related mortality 3-fold, according to the American College of Cardiology 2