NSAIDs and GI tolerability

Recently, the Australian Medicine’s Handbook officially recognised that ibuprofen can be taken with water alone. 1 With that in mind, it is timely to revisit the issue of non-steroidal anti-inflammatory drugs (NSAIDs) and their gastrointestinal (GI) tolerability.

GI problems—not a class effect
 
The main concern with NSAIDs is their potential to produce GI toxicity, in some cases resulting in GI bleeding and perforation. However, GI tolerability among NSAIDs is not a class effect. Strong evidence demonstrates that ibuprofen is the best tolerated of all NSAIDs, even when it is taken at prescription doses.2
 
The pharmacokinetic properties of individual NSAIDs may contribute to their potential to cause GI toxicity. Ibuprofen, for example, has a relatively short half-life which may be a factor in its relatively low incidence of GI side effects. 2 One study showed that NSAIDs with a long half-life, such as piroxicam, or slow-release formulations are associated with a greater risk of upper GI bleeding/perforation. 3
The PAIN study compared three commonly used analgesics at over-the-counter doses. In this study, the overall tolerability of ibuprofen was equivalent to that of paracetamol and significantly better than that of aspirin (P<0.001). When it came to GI tolerability, ibuprofen had a significantly better profile than the other agents and the incidence of abdominal pain was significantly lower for ibuprofen-treated patients.4

1. Australian Medicines Handbook. 2014. (Accessed at www.amh.net.au.)
2. Hetzel D. Aust J Pharmacy 2011;92:93-6.
3. Masso Gonzalez EL, et al. Arthritis Rheum 2010;62:1592-601.
4. Moore N, et al. Clin Drug Invest 1999;18:89-98.