Antacid increases NSAID erosion risk

Including an antacid in an ibuprofen preparation may increase the risk of gastric erosions, study findings from Finland suggest. Recognizing that magnesium hydroxide may increase the rate of ibuprofen absorption, Jukka Menp (Santen Oy, Tampere) and colleagues determined whether preparations containing the buffer affected gastrointestinal tolerability of the drug.

Including an antacid in an ibuprofen preparation may increase the risk of gastric erosions, study findings from Finland suggest. Recognizing that magnesium hydroxide may increase the rate of ibuprofen absorption, Jukka Menp (Santen Oy, Tampere) and colleagues determined whether preparations containing the buffer affected gastrointestinal tolerability of the drug. The team conducted a double-blind, randomized, cross-over trial involving 20 healthy men who were given 800 mg of ibuprofen three-times daily in a standard preparation of two 400-mg tablets, or in two tablets containing 400 mg ibuprofen plus 200 mg magnesium hydroxide. Endoscopy was performed before treatment and again 5 days later, 2 hours after the morning dose was taken. In addition, gastric pH and plasma ibuprofen concentrations were measured. As reported in the Journal of Clinical Gastroenterology, endoscopy revealed that the volunteers had a higher number of evincing erosions after using the magnesium hydroxide-containing preparation than with the conventional ibuprofen tablets. Specifically, erosions were detected in the gastric corpus of seven and two participants, respectively, and in the gastric antrum of 13 and five volunteers, respectively. As expected, there was a trend towards higher absorption for the magnesium hydroxide preparation than conventional treatment. Menp et al therefore conclude: “Prolonged use of magnesium hydroxide together with high doses of ibuprofen should be avoided, because the combination may incur a higher risk of gastrointestinal irritation.”(Source J Clin Gastroenterol 2004; 38: 41-45)