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The Combination of an NSAID with a PPI Can Harm the Gut

A study revealed unexpected damage to the small intestine from the combination of an NSAID with a PPI; changes in gut flora may be responsible.

Using one medication to treat the known side effects of another pill often seems sensible. Unfortunately, it doesn’t always work. In some cases, adding the second medicine can backfire. The combination of an NSAID with a PPI can cause unexpected intestinal damage.

Q. I am on NSAIDs for joint pain. Unfortunately I can’t live without the ketoprofen. It allows me to walk and cook and take care of my family.

I’m also taking Nexium for reflux. I was under the impression that drugs like Nexium would protect my digestive tract but I read on your website that this combination might be damaging my small intestine.

I’m trying to eat yogurt to bolster my good gut bacteria. It seems we can’t win, when we end up taking drugs for the side effects of our other drugs.

Digestive Tract Injury From the Combination of an NSAID with a PPI

A. The study found that acid-suppressing drugs (PPIs) can protect the stomach lining, but they increase the damage NSAIDs such as ibuprofen, ketoprofen and naproxen do to the small intestine (Mayo Clinic Proceedings, Dec., 2014). The authors found that PPIs change the bacteria living in the digestive tract; this could make the intestinal wall more susceptible to harm from NSAIDs.

Other Approaches to Easing Joint Pain

We don’t know if they will work for you, but there are many non-drug approaches to reducing inflammation and joint discomfort. Herbs such as boswellia or curcumin and foods like tart cherries or pomegranates can all be helpful. For more details on these and other options, we are sending you our Guide to Alternatives for Arthritis.

Perhaps with less reliance on ketoprofen, which has the potential to cause serious problems for the digestive tract, you won’t need to add Nexium. You may also want to learn about treating reflux without drugs from our Guide to Digestive Disorders.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.”.
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