ModerateInhaled corticosteroids (ICS)×Non-steroidal anti-inflammatory drugs (NSAIDs)
Updated · Methodology
Mechanism
Additive GI ulcer and bleeding risk with systemic budesonide. Inhaled budesonide does not clinically affect risk.
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, limit ibuprofen to short courses (no more than 5–7 days) with pantoprazole 20 mg/day. For long-term analgesia: paracetamol up to 2 g/day. Inhaled budesonide with ibuprofen is safe. In older patients and prior peptic ulcer, risk outweighs benefit — consider paracetamol or topical NSAIDs.
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Sources
- FDA: Pulmicort (budesonide) prescribing information (2010)– ; DailyMed setid ae1105cd-69fc-4c15-937f-c535304341c2