ModerateInhaled corticosteroids (ICS)×Selective COX-2 inhibitor (coxib)
Updated · Methodology
Mechanism
Glucocorticoid plus NSAID — additive GI ulcer risk with systemic budesonide. Celecoxib (selective COX-2 inhibitor) gives lower gastric risk than non-selective NSAIDs, but the effect persists.
Symptoms
Epigastric pain, heartburn, black or tarry stools, blood in vomit, bruising. Higher risk in older patients, prior peptic ulcer, and concurrent anticoagulants.
Management
On systemic budesonide and celecoxib, in older patients, prior peptic ulcer, or long-term therapy: pantoprazole 20 mg/day. Alternatives in osteoarthritis: topical NSAIDs, paracetamol up to 2 g/day. Inhaled budesonide with celecoxib is safe.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
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Sources
- FDA: Celebrex section 7 (2012)– ; DailyMed setid 2d6675e4-5859-4be2-8037-a20ce9f707aa