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Table 1 Guidelines for NSAID use

From: Current state of therapy for pain and inflammation

  NSAID alone NSAID + PPI COX-2 COX-2 + PPI
Appropriate Age <65 years, no aspirin and no previous gastrointestinal event On aspirin Previous gastrointestinal event On aspirin and no previous gastrointestinal event Not on aspirin and previous gastrointestinal event Previous gastrointestinal event and on aspirin On aspirin and steroids/warfarin
Inappropriate Previous gastrointestinal event
On aspirin, steroids, or warfarin
Age <65 years, not on aspirin and no previous gastrointestinal event - Not on aspirin and no previous gastrointestinal event
Age <65 years, on aspirin but no previous gastrointestinal event
Age <65 years, previous uncomplicated gastrointestinal event and not on aspirin, steroids, or warfarin
  1. Shown are guidelines for nonsteroidal anti-inflammatory drug (NSAID) use prior to rofecoxib withdrawal [9]. COX, cyclo-oxygenase; PPI, proton pump inhibitor. Reproduced with permission from [9].