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Table 2 Clinicians' guide to anti-inflammatory therapy (reproduced from reference [15], with permission)

From: OTC analgesics and drug interactions: clinical implications

  No or low NSAID gastrointestinal risk NSAID gastrointestinal risk
No cardiovascular risk (without aspirin) Nonselective NSAID (cost consideration) COX-2 selective inhibitor or nonselective NSAID and proton-pump inhibitor
   COX-2 selective inhibitor and proton-pump inhibitor for those with prior GI bleeding
Cardiovascular risk (with aspirin) Naproxena Proton-pump inhibitor irrespective of NSAID
  Addition of proton-pump inhibitor if gastrointestinal risk of aspirin/NSAID combination warrants gastroprotection Naproxen if CV risk outweighs GI risk
   COX-2 selective inhibitor and proton-pump inhibitor for those with previous GI bleeding
  1. COX = cyclooxygenase; CV = cardiovascular; GI = gastrointestinal; NSAID = nonsteroidal anti-inflammatory drug.
  2. aNonselective or selective (low-dose) inhibitor without established aspirin interaction if naproxen is ineffective.
  3. Misoprostol at full dose (200 μg four times a day) may be substituted for proton-pump inhibitor.