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Dyspepsia - unidentified cause - Management
How should I manage drugs, other than NSAIDs, known to increase the risk of gastrointestinal bleeds or exacerbate dyspepsia?
- The management of drugs, other than nonsteroidal anti-inflammatory drugs (NSAIDs), that are known to increase the risk from gastrointestinal bleeding, dyspepsia, or ulceration (including those in Table 1) will depend on clinical judgement of the benefits and risks of continued treatment. When there is doubt seek specialist advice. Management options include:
- Stopping the drug.
- Reducing the frequency or dose of the drug.
- Substituting the drug for one less likely to cause bleeding or dyspepsia.
- Continuing the drug and prescribing a gastroprotective agent.
Clarification / Additional information
- Table 1 gives examples of common drugs known to cause gastrointestinal (GI) bleeding, dyspepsia, or ulceration.
Table 1. Examples of common drugs known to cause GI bleeding, dyspepsia, or ulceration.
Therapy Group | Examples |
|---|
Antiplatelets* | Aspirin, clopidogrel |
Anticoagulants* | Warfarin |
Corticosteroids* | Prednisolone |
Nonsteroidal anti-inflammatory drugs (NSAIDs)* | Aspirin, ibuprofen, diclofenac, naproxen, indometacin |
Antibiotics | Macrolides (e.g. erythromycin, metronidazole) |
Antidepressants - Selective serotonin-reuptake inhibitors (SSRIs) | Fluoxetine, paroxetine |
Bisphosphonates | Alendronic acid, sodium risedronate |
Calcium-channel blockers | Nifedipine, diltiazem, verapamil |
Iron | Ferrous sulphate |
Nitrates | Isosorbide mononitrate |
Potassium-channel activator† | Nicorandil |
Xanthine bronchodilator | Theophylline |
Others | Colchicine, levodopa, digoxin, potassium chloride, quinidine |
* Increased risk of GI bleeds with these drugs. |
† Nicorandil is associated with a risk of gastrointestinal ulceration, including perianal ulceration. Ulcers that result from nicorandil are refractory to treatment, including surgery; they respond only to withdrawal of nicorandil. |
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Basis for recommendation
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