NSAID with least GI side effects

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
D

deltaforce

Full Member
10+ Year Member
Joined
Apr 23, 2010
Messages
37
Reaction score
1
Just curious if anybody has any idea on NSAID that has least gastro-intestinal side effects. I know Relafen (Nabumetone) is one. Any other, like Celebrex (Celecoxib)?

Thanks in advance.
Members don't see this ad.
 
Members don't see this ad :)
deltaforce said:
Just curious if anybody has any idea on NSAID that has least gastro-intestinal side effects. I know Relafen (Nabumetone) is one. Any other, like Celebrex (Celecoxib)?

Thanks in advance.
Click to expand...

For chronic use, you can add on a gastroprotective agent.
 
rxlea said:
For chronic use, you can add on a gastroprotective agent.
Click to expand...

Like? which one would you suggest to check with the doctor?

The patient has used Naproxen, Advil and both cause serious gastric troubles. Relafen has been good so far. I noticed that Relafen is non-acidic NSAID but I am not too sure of others like Toradol, Mobil and Celebrex.
 
deltaforce said:
Like? which one would you suggest to check with the doctor?

The patient has used Naproxen, Advil and both cause serious gastric troubles. Relafen has been good so far. I noticed that Relafen is non-acidic NSAID but I am not too sure of others like Toradol, Mobil and Celebrex.
Click to expand...

Just a guess as I've only touched on this subject, but what about adding misoprostol (obviously only in non-pregnant patients)? Don't take my recommendation as fact; I haven't hit the NSAID unit in my college yet.
 
deltaforce said:
Like? which one would you suggest to check with the doctor?

The patient has used Naproxen, Advil and both cause serious gastric troubles. Relafen has been good so far. I noticed that Relafen is non-acidic NSAID but I am not too sure of others like Toradol, Mobil and Celebrex.
Click to expand...

Depends on the patient... How old is this patient and are there any other disease states to consider?
 
Celebrex is an option but consider patient's age and risk factors since it has a higher risk of cardiovascular effects. Like someone else mentioned you can also use a gastroprotective agent like a PPI or Misoprosol if patient is not in childbearing age.
 
deltaforce said:
Like? which one would you suggest to check with the doctor?

The patient has used Naproxen, Advil and both cause serious gastric troubles. Relafen has been good so far. I noticed that Relafen is non-acidic NSAID but I am not too sure of others like Toradol, Mobil and Celebrex.
Click to expand...

Any Cox-II selective will be better. Add a PPI like omeprazole. Misoprostol is relatively contraindicated in premenopausal women and has a lot of adverse effects that omeprazole doesn't.
 
Members don't see this ad :)
Carboxide said:
Any Cox-II selective will be better. Add a PPI like omeprazole. Misoprostol is relatively contraindicated in premenopausal women and has a lot of adverse effects that omeprazole doesn't.
Click to expand...

Keep in mind that PPIs are now associated with increased risk of cdiff. For FDA even issued a warning last year on that. For prophylaxis, h2ra is as efficacious as PPI.
 
xiphoid2010 said:
Keep in mind that PPIs are now associated with increased risk of cdiff. For FDA even issued a warning last year on that. For prophylaxis, h2ra is as efficacious as PPI.
Click to expand...

Right...but if the patient isn't hospitalized, it's pretty low risk still.
 
To elaborate more, the patient is 35 year old male, diagnosis of Ulcerative colitis (He is from a local support group that I am a part of), uses NSAID as an abortive for his migraines. Using Verapamil 320mg/day and Nortryptyline 20mg/day as migraine prophylactic. Migraine episode is about once a week.
Have tried all triptans but they do not work. Only NSAIDs work, if taken within an hour of migraine episode start.

The patient does not have any other diagnosed medical condition. He is pretty fed up with his neurologist as he can not come up with any new abortive suggestion. And because of the insurance situation, he can not see any other neurologist. Too complicated situation to explain here. Ulcerative colitis stays in remission, if he suffers migraine (by not taking an abortive). If he takes NSAID, it puts him in Ulcerative colitis flare. Lost job as a result of it (Boss did not like him going to the restroom many a times, was fired, aka position eliminated.).

He has tried Prilosec OTC along with NSAID, it did not help. Currently using Relafen 750mg, which works about 80% of the times. He is looking for alternative should Relafen goes Advil or Alleve way (i.e. starts putting him in flare). The patient does not intend to reproduce.

I am NOT asking this as a medical advice. I want to give this guy pointers which he could talk with his neurologist. I dug through the literature and I find hardly any literature that has really any data on this combination, so I am here for experienced opinions.

Many thanks in advance.
 
Topamax would be another drug the Pt can add as a prevention med, pretty minimal sideeffct.

As for Nsaid, etodolac, Meloxicam, and nabumatone are semi-cox selective and GI sparing.. Celebrex is cox-2 selective. But if the patient is only taking 1x per week PRN migraine, I'm not sure pt needs any long term GI prophylaxis unless there is a hx of GI bleed. Maybe just a tums or 2 if he gets GI upset?
 
Last edited:
deltaforce said:
To elaborate more, the patient is 35 year old male, diagnosis of Ulcerative colitis (He is from a local support group that I am a part of), uses NSAID as an abortive for his migraines. Using Verapamil 320mg/day and Nortryptyline 20mg/day as migraine prophylactic. Migraine episode is about once a week.
Have tried all triptans but they do not work. Only NSAIDs work, if taken within an hour of migraine episode start.

The patient does not have any other diagnosed medical condition. He is pretty fed up with his neurologist as he can not come up with any new abortive suggestion. And because of the insurance situation, he can not see any other neurologist. Too complicated situation to explain here. Ulcerative colitis stays in remission, if he suffers migraine (by not taking an abortive). If he takes NSAID, it puts him in Ulcerative colitis flare. Lost job as a result of it (Boss did not like him going to the restroom many a times, was fired, aka position eliminated.).

He has tried Prilosec OTC along with NSAID, it did not help. Currently using Relafen 750mg, which works about 80% of the times. He is looking for alternative should Relafen goes Advil or Alleve way (i.e. starts putting him in flare). The patient does not intend to reproduce.

I am NOT asking this as a medical advice. I want to give this guy pointers which he could talk with his neurologist. I dug through the literature and I find hardly any literature that has really any data on this combination, so I am here for experienced opinions.

Many thanks in advance.
Click to expand...

What about these ideas?

-IM ketorolac at onset (we have a few patients who do this) (I THINK the risk for GI bleed is lower with IM onset, but still some risk.)
- butorphanol nasal spray
-ergotamine
-opioids
 
PRN loperamide during the flares, if he starts having flares with Relafen?
 
Carboxide said:
What about these ideas?

-IM ketorolac at onset (we have a few patients who do this) (I THINK the risk for GI bleed is lower with IM onset, but still some risk.)
- butorphanol nasal spray
Click to expand...

DO NOT use butorphanol on an outpatient basis!!!!!!!!! EVERY patient I've ever encountered who used it because hopelessly addicted within a very short time. And this has included several pharmacists.

Toradol should never be used, IM, IV, or PO, for more than 5 days combined. Maybe teaching him how to give himself an IM injection would work; IDK.

Do they even make Cafergot or Ercaf any more? I haven't seen it in ages.
 
deltaforce said:
Like? which one would you suggest to check with the doctor?

The patient has used Naproxen, Advil and both cause serious gastric troubles. Relafen has been good so far. I noticed that Relafen is non-acidic NSAID...
Click to expand...

The acidity of the agent itself is of no concern. In fact, all of the suggestions of PPIs and H2RA's are probably nonsense. If the problem is ulcerative colitis (i.e. issues at the end of the GI tract, not the beginning), all the gastro-protective suggestions are most likely a waste of time. The problem is caused by a decrease in GI-protective mucous as a result of COX-1 inhibition. Celebrex or Cytotec are the best options here. I'd opt for the Cytotec add-on therapy since Relafen is working well, and we can avoid pricey brand-name agents.
 
I can not thank you folks enough for all the help.

I suggested him Relafen a year ago and neuro agreed to prescribe, so far so good.

The patient has tried Topamax, Metoprolol without any benefit. Since he uses NSAID once a week/PRN, the theory, he does not need a gastroprotective agent but since he is a patient of ulcerative colitis, it doesn't matter how often he takes it, if he takes Advil or Alleve anytime, it results in flare (within 4 hours). I suppose his GI linings are so messed up as a result of ulcerative colitis or previous use of daily NSAID for migraine that he doesn't stand even a single dose. (In the past, he had daily migraines. His migraine episode of 1X/wk is for last 1.5 years only)

He has tried opiod derivatives as abortive but they do not help either. He has also tried Fioricet and Dolgic Plus, no effect.

When in flare, I am against Immodium. The new guidelines point towards pancreatitis. In Ulcerative colitis patients, pancreas, gall bladder and liver are on high alert so I would not add something to mess it up further. Instead, Bentyl is my choice of drug. Works good and darn cheap. (This is not one or 2 tablet that we are talking about, you could run out of 30 doses in a matter of a week)
Plus, Bentyl or Immodium will only reduce the number of trips he makes to the restroom, that does not cure the flare. Only Prednisone course helps. He has been through 3 courses during one year and such Prednisone use is certainly not good for a 35 year old male. So the goal here is to find a NSAID that works and does not put him in ulcerative colitis flare.

I am not in favor of Ergot derivatives because of their cardiovascular side effects and in his case, the cost issues. He has $7000 or so deductible.

@npage148,
You suggested organic nitrates as gastroprotectives. Could you give me some brand names please?

@zelman,
You probably hit the nail. I am thinking on the same lines. Because of ulcerative colitis inflammation, his gastroprotective mucus is either less or totally gone. When you add regular OTC NSAID like Advil or Alleve or similar on top of it, it even worsens the situation. This worsened situation results in ulcerative colitis flare. That the is only reason, I thought of Celebrex. I don't know if there is any other equivalent/similar to Celebrex that he doesn't pay through his nose to get the same effect.

Cytotec could be a great addition but in your experience how does it compare to PPI? The literature says, it just works same (again the subjects were not ulcerative colitis patients, they were regular patients) He has used PPIs (in all honesty, not that often) but has not achieved the effect. He used to add a Prilosec OTC with his NSAID at the time of migraine episode. I don't know if PPIs should be taken regularly to achieve similar effect or just with the NSAID. Again, you should not take PPIs for more than 2 weeks (but I know folks taking it for years).

Thank you everyone for the contribution.
 
deltaforce said:
@zelman,
You probably hit the nail. I am thinking on the same lines. Because of ulcerative colitis inflammation, his gastroprotective mucus is either less or totally gone. When you add regular OTC NSAID like Advil or Alleve or similar on top of it, it even worsens the situation. This worsened situation results in ulcerative colitis flare. That the is only reason, I thought of Celebrex. I don't know if there is any other equivalent/similar to Celebrex that he doesn't pay through his nose to get the same effect.

Cytotec could be a great addition but in your experience how does it compare to PPI? The literature says, it just works same (again the subjects were not ulcerative colitis patients, they were regular patients) He has used PPIs (in all honesty, not that often) but has not achieved the effect. He used to add a Prilosec OTC with his NSAID at the time of migraine episode. I don't know if PPIs should be taken regularly to achieve similar effect or just with the NSAID. Again, you should not take PPIs for more than 2 weeks (but I know folks taking it for years).

Thank you everyone for the contribution.
Click to expand...

Most patients with ulcers or GI damage leading up to ulcers will have the damage occur in the stomach or duodenum where the acid from the stomach and proteolytic enzymes are present. That is the only condition about which you will find any data. This is something different altogether. I can speak about typical GI injured patients' use of different agents, but I don't think they apply here. For example, PPIs work best when used regularly, though they do cause rebound acidity, and their 2 week restriction is a labeling concession made to the FDA so patients would go see a doctor if they got a bleeding ulcer/stomach cancer. But PPIs and other agents like Carafate are not going to do anything in the colon. Functional similarities are overcome by anatomical distance here. I've never had a patient use cytotec for your case's purpose, so I can't speak to it. But pharmacologically, it's the only one that will influence intestinal mucous.

Oh, and all the COX-2 inhibitors besides Celebrex left the market when Vioxx was found to have negative cardiac outcomes.
 
So does this patient have to take cytotec qid along with his nsaid dose or cytotec daily to prevent UC flares? Although impractical, would a carafate enema be worth anything?
 
Carboxide said:
What about these ideas?

-IM ketorolac at onset (we have a few patients who do this) (I THINK the risk for GI bleed is lower with IM onset, but still some risk.)
- butorphanol nasal spray
-ergotamine
-opioids
Click to expand...

Just a couple of things to keep in mind...

The risk of GI bleeding is the same with IM use because the bleeding is related to the prostaglandin effects. Changing the route (other than using a minimally-absorbed topical) will not decrease the risk of GI bleeds. If we're talking upset stomach, then the route will make a bigger difference.

I saw some people suggesting misoprostol, but this may not be the best recommendation. There's some pretty nasty diarrhea associated with its use, so that's why it's not so common (besides teratogenicity). A PPI will be equally protective and not have diarrhea associated with misoprostol.

Luckily, just talked about this stuff with my preceptor yesterday. Excellent timing =)
 
PharmDHawkeye said:
Just a couple of things to keep in mind...

The risk of GI bleeding is the same with IM use because the bleeding is related to the prostaglandin effects. Changing the route (other than using a minimally-absorbed topical) will not decrease the risk of GI bleeds. If we're talking upset stomach, then the route will make a bigger difference.

I saw some people suggesting misoprostol, but this may not be the best recommendation. There's some pretty nasty diarrhea associated with its use, so that's why it's not so common (besides teratogenicity). A PPI will be equally protective and not have diarrhea associated with misoprostol.

Luckily, just talked about this stuff with my preceptor yesterday. Excellent timing =)
Click to expand...

Do you really think a PPI will influence ulcerative colitis flares? Not a rhetorical question. My intuition is that the stomach acid reduction has little to no effect once the chyme (or feces or whatever the correct term at this point in the GI tract) has reached the colon. Have you found data on this subject? Is this the topic you had discussed with your preceptor? Or were you just focusing on stomach problems?
 
based on mechanism the more selective cox2 inhibitors since cox1 enzyme is involved with PG production that is actually protective of endotherlial cell of GI tract. So that would be celebrex or mobic(the highest affinity for cox2 compared to other nsaids)

correct me if i'm wrong guys.
 
For organic nitrates, you are going to need to extrapolate dosing from clinical studies involving NO releasing hybrids and what other scant clinical studies. But then again, ORN induce headaches so I'm sure they patient would stop them in about 2 doses
 
rxlea said:
Here is a thought: what is triggering his migraines?
Click to expand...

What is this nonsense? Everyone knows the correct way to practice medicine is to throw more drugs at the problem.

This kind of thinking won't get you anywhere.
 
I have been spending more time with this guy on the phone to answer the question raised. Good point is, the guy is at least smart enough to produce 5 years of his diary which I dug through.

Here are the details -
No pattern in any damn thing that I can see, location, timing, duration, trigger factors, severity, really nothing. I wonder how the heck somebody should treat this migraine. He even did dosing of MSG and red wine, not a thing. Weather is not a factor, really nothing. He has tried a lot of weird stuff (something called as traction at PT place) but no effect. So what is causing this migraine is a mystery, unless it is connected to UC in any way.

This is my theory, serotonin levels in UC are low as a result of intestinal inflammation. Can serotonin play any role in triggering his migraine?
Plus, Verapamil works as prophylactic, which essentially eases up the blood vessels. On the other hand, triptans constrict them and they do not work. I am unable to place the role that Advil plays in this story, in terms of the effect on blood vessels (or its just killing the messenger?) Can anyone stretch this and make some theory? I told him to discuss this part with his neuro and ask if he is interested in putting him on low dose of tricyclic antidepressant. Pls tell me if I am making any sense or look like a drunken fella rumbling.

Lets keep PPIs out of discussion, they do not do a thing. And PPIs play role way up above in GI system compared to Ulcerative colitis, so they are out of discussion. The problem is NOT stomach but large intestine, descending colon in his case.

If I understood correctly, we are short listing Celebrex and Mobic. How about a gastroprotective agent? Organic nitrate are out because of the lack of data and nastiness of the medication as a whole. Misprostol? terratogenicity is not an issue here, he is not going to produce any offsprings and how about sucralfate? His anus is already irritated because of ulcerative colitis and the enemas he uses to treat it but I am sure if sticking up one more bottle is going to resolve his flares, he would happily do it.

Feel free to correct me or if I don't make sense.

Thanks a ton for great inputs and pretty good discussion. I really hope, I can give me couple of options at the end.
 
Has he tried acetaminophen?
A lot of patients with UC cannot tolerate NSAIDs at all.
 
Inia said:
Has he tried acetaminophen?
A lot of patients with UC cannot tolerate NSAIDs at all.
Click to expand...

Do you know that we're talking about treating migraines? There's a reason that Treximet has naproxen.
 
I feel so bad for this patient, just reading about him. Are NSAIDs the only thing that causes his UC to flare? Is he otherwise well controlled? I'm not that familiar with UC treatment, but is there some way his UC could be brought under control enough that he might not flare with NSAIDs?
 
@Inia,

He has tried Tylenol at many strengths (regular, extra and double extra) but no help

@radio frequency,
His UC seems to be very well controlled. As the migraine strikes, he has no other option but to take a NSAID. As soon as he takes NSAID, within 4 hours, he starts bleeding profusely and then the only option he has is oral Prednisone. Since last year, I suggested him Relafen, he had only 2 flares. Actually, he started Relafen when his GI suggested him really LONG dose of Pred (that lasted for 6 months) so we were unable to figure out if Relafen was really working.
After June of last year, he was fine until Thanksgiving and he was using Relafen 1X/wk (on an average). The day before thanksgiving, he suddenly got constipated, never had that before to him (usually diarrhea is in an issue with UC but rarely constipation). He got constipated to an extent that he did not use restroom for a week. He used a ton of stuff like stool softner, miralax, citrucel to get the stuff out but it came out with truck load of blood and thus he went into a flare. Thankfully, his GI has some sense and he refused to give him oral Pred (for the side effect, the guy has done a totol of 10 Pred courses over the period of 3.5 years, to control flares resulting from NSAID use). Now he is using rectal hydrocortisone and mesalamine to get it in control. The results are iffy but at least he can do his regular day work.
radio frequency said:
but is there some way his UC could be brought under control enough that he might not flare with NSAIDs?
Click to expand...
That is a million dollar question. If anybody figures this out then essentially we are removing ALL gastric bleeding side effects of NSAID and we will make NSAID super preferred choice of treatment of majority of indications.

To cut long story short, I think that Relafen is working but as and when he is at the support group, he is afraid that one day Relafen will stop working (Naproxen worked for him without flares for about 2 years) and then what is he gonna do? He seems to be worried more about migraines than the UC itself (which I totally understand).

On the other hand, I asked him, could it be that mesalamines are triggering this headache? Mesalamines also have headache as a side effect but he claims that the headaches started before his UC symptoms. And if he is not going to take mesalamines then there is really nothing he could use for UC. He is already on Imuran. He can not afford to go to on biologics and even if his insurance suddenly turns generous, how long that Humira and Remicade is going to work, ~5 years? then he will have to go under the knife anyways so why not go now is his question.

We all at the support group really want to help this guy out but we are all out of ideas, so I turned here. So far, I have 2 options of Celebrex and Mobic that I could suggest him but I liked the idea of adding gastroprotective agent. I just don't know if there is any that will work good in such situation.
 
Just an FYI, I think adding other immunosuppressives to biologic therapy (for example, azathioprine with Remicade in Crohn's patients) can help the biologics work longer. They really do work wonders for many patients with certain conditions, even if they're expensive and seem scary. Besides, if they stop working in 5 years, there may be a new biologic on the market already...

Sounds like there is a lot to consider with this patient. Most of it is, unfortunately, beyond my current capabilities, but GI bleeds are serious enough that I might start looking for other options. A gastroprotective agent may not be enough...
 
Great discussion. I don't disagree with many of the comments above, but I don't think it would hurt to make the discussion a little more evidence-based by throwing out some articles.

Here's a great in vitro study that looked at COX-2 specificity of a bunch of NSAIDs. I've included Figure 3 below -- the image speaks for itself (article at http://www.ncbi.nlm.nih.gov/pubmed/10377455):
tileshop.fcgi


These are two articles that are clinical studies looking at the GI toxicity (albeit not related to ulcerative colitis) of NSAIDs:

Henry et al. BMJ. 1996 Jun 22;312(7046):1563-6.
http://www.ncbi.nlm.nih.gov/pubmed/8664664

García Rodríguez et al. Arch Intern Med. 1998 Jan 12;158(1):33-9.
http://www.ncbi.nlm.nih.gov/pubmed/9437376
 
@ radio frequency,
Although what you say is true, in terms of little longer help from a biologic. Current bunch of subjects report that once one biologic stops working, the other one does not work as long. So although other biologic may come in the market, if they have similar MOA, its not going to fly.

@CritCare PharmD,
The study is great, wish it was little newer. Rofecoxib is pulled out. I don't know if those cryptic drugs made it to the shelf but will be glad to find out.

WIll look at other studies too and also search some on Pubmed.

Thanks again.
 
deltaforce said:
@ radio frequency,
Although what you say is true, in terms of little longer help from a biologic. Current bunch of subjects report that once one biologic stops working, the other one does not work as long. So although other biologic may come in the market, if they have similar MOA, its not going to fly.
Click to expand...
JAK inhibitors should hit the market within the next few years. Will be interesting to see how it all plays out, as the data looks promising vs. the anti-TNFs so far.
 
PharmDHawkeye said:
Just a couple of things to keep in mind...

I saw some people suggesting misoprostol, but this may not be the best recommendation. There's some pretty nasty diarrhea associated with its use, so that's why it's not so common (besides teratogenicity).
Click to expand...

The whole discussion mentioned 8 times the word Misoprostol and I have not seen my trick so allow me to share. This may help someone.


Case report:
Misoprostol: little secret of its helpfulness: Misoprostol at low dose did not cause diarrhea.
Male personal experience: using Misoprostol 100 milligrams a pill, 1 at a time.
First day: 100 mg only. No diarrhea.
Second day: 200 mg only. No diarrhea. (100 milligrams a time, 2 times a day.)
Third day: 300 mg only. No diarrhea. (100 milligrams a time, 3 times a day.)
Fourth day: 400 mg only. No diarrhea. (100 milligrams a time, 4 times a day.)
Fifth day: 500 mg only. diarrhea. (100 or 200 milligrams a time, 4 times a day.)

What's the tip from this case?
Low dose of Misoprostol worked at rebuilding mucous layer in the GI tract (evidenced as the small stomach ulcer was healed in 1 week) and did not cause diarrhea. Perhaps, this may help this poor patient somehow in his GI tract? (or fellow pharmacist with stomach ulcer)?

Patient will have to try 100 milligrams a day until patient finds own level of misoprostol that will not cause diarrhea.

Source: Facts and Comparisons (under Fair Use License for Educational Purpose.)
Found under Adverse Reaction, GI section:
".....Diarrhea was dose related and usually developed early in the course of therapy (after 13 days), usually was self-limiting (often resolving after 8 days)......"
+++++++++++++++++++++++
Does Misoprostol has a potential to help in colon? Very likely yes. My clue: Misoprostol was potential helper in treating epithelial damage in mouth and colon.

Hanson WR, Marks JE, Reddy SP, Simon S, Mihalo WE, Tova Y. Protection from radiation-induced oral mucositis by a mouth rinse containing the prostaglandin E1 analog, misoprostol: a placebo controlled double blind clinical trial. Adv Exp Med Biol. 1997;400B:811-818. PubMed


Hille A, Schmidberger H, Hermann RM, et al. A phase III randomized, placebo-controlled, double-blind study of misoprostol rectal suppositories to prevent acute radiation proctitis in patients with prostate cancer. Int J Radiat Oncol Biol Phys. 2005;63(5):1488-1493. PubMed

+++++++++++++++++++++++
There is hope for this patient....Good luck.
 
Last edited:
Carboxide said:
Right...but if the patient isn't hospitalized, it's pretty low risk still.
Click to expand...
I've seen it quite frequently actually. Just out of curiosity, do you think all hospitalized pts need a PPI for stress ulcer prophylaxis?
 
molyhelp said:
".....Diarrhea was dose related and usually developed early in the course of therapy (after 13 days)
Click to expand...
So if diarrhea usually develops after 13 days, it doesn't seem to be some big stunner that there was no diarrhea at day 4-5.

I wonder how the rest of the case has developed in the previous 14 months.
 
VCU07 said:
I've seen it quite frequently actually. Just out of curiosity, do you think all hospitalized pts need a PPI for stress ulcer prophylaxis?
Click to expand...

I feel vehemently that stress ulcer prophylaxis should be avoided unless the patient is a). in the ICU, and b). has other risk factors.

Stress ulcer prophy is not harmless and comes with serious adverse effects. It raises the risk of C. diff, and also C. diff recurrence, by up to 65%.
 
  • Like
Reactions: 1 users
Following up on RXLea suggestion....I think its possible that the meslamine could be triggering headaches, but it sounds like he really can't stop that at this point because of the UC. Still, has he ever seen an allergist? I think it would be worth it to consult with an allergist to rule out the possibility that he could have an allergy to something that is triggering his migraine.
 
You must log in or register to reply here.
Next unread thread

Similar threads

M
Part-time, remote pharmacist side hustles...
Replies
15
Views
2K
projektreverb
P
J
Any pharmacist side hustle ideas to get 1099 income (not w2)
Replies
25
Views
4K
RXDOC1986
R
D
Side hustles?
2 3 4
Replies
197
Views
14K
aqb
A
A
Most to least valuable college majors
Replies
16
Views
2K
StockPharmD2020
S
P
Which retail pharmacy offers the least covid services?
Replies
6
Views
1K
WVUPharm2007
WVUPharm2007
Top