Dexamethasone × Diclofenac

Both labels point to the same spot from opposite sides. The dexamethasone label states that non-steroidal anti-inflammatories, for example indometacin and salicylates, increase the risk of ulcer and gastrointestinal bleeding. The diclofenac label notes that concomitant use with other NSAIDs or corticosteroids can increase gastrointestinal adverse effects. The steroid also retains sodium and raises blood glucose, adding to the renal and blood pressure effect of the NSAID.

Epigastric pain, nausea, black stools, coffee-ground vomit. The steroid masks fever and pain, so a perforation may present with few symptoms. Add high blood glucose in diabetics, oedema and rising blood pressure.

Avoid overlapping the two unless clearly indicated, and then for the shortest time. When the combination is necessary, add gastric protection with a proton pump inhibitor and monitor stools, haemoglobin and blood glucose. For background pain, paracetamol allows the NSAID to be reduced or dropped.