Acetylsalicylic acid × Methylprednisolone

Glucocorticoids damage the gastric mucosa and suppress protective prostaglandin production. Aspirin compounds the risk of GI ulcer and bleeding.

Epigastric pain, nausea, heartburn. With prolonged therapy: peptic ulcer and GI bleeding risk (black stools, vomiting blood). Older patients and prior peptic ulcer disease: higher risk.

Aspirin SmPCs, including those for 100 mg tablets, advise against combining aspirin with systemic glucocorticoids because together they raise the risk of ulcers and gastrointestinal bleeding (aspirin 100 mg and 500 mg SmPCs). If the combination cannot be avoided, use it with caution: tell the patient in advance about the signs of bleeding (black stools, vomiting blood, marked weakness, low blood pressure, cold sweat, abdominal pain, dizziness) and that if they appear, aspirin is stopped and they must see a doctor at once (aspirin SmPCs). The methylprednisolone SmPC also asks for patient monitoring: methylprednisolone can speed up salicylate elimination and weaken its effect (methylprednisolone SmPC). In patients on long-term high-dose aspirin, salicylate levels can rise to toxic values when methylprednisolone is withdrawn (US methylprednisolone label).