When prescribing NSAIDs, which NSAID poses the greatest risk of gastrointestinal toxicity?

When prescribing NSAIDs, which NSAID poses the greatest risk of gastrointestinal toxicity?

• A. Diclofenac
• B. Ibuprofen
• C. Piroxicam
• D. Celecoxib

Answer: (C)

The risk of gastrointestinal toxicity from NSAIDs is mainly driven by how much the drug inhibits COX-1, which reduces the protective prostaglandins that guard the stomach lining, and by how long the drug stays in the body. Piroxicam is a nonselective NSAID with potent COX-1 inhibition and a relatively long duration of action, so it exposes the gastric mucosa to these harmful effects longer and more strongly. This combination leads to a higher likelihood of gastric ulcers, erosions, and bleeding compared with the others listed. In contrast, celecoxib is COX-2 selective and tends to spare the stomach, reducing GI risk; ibuprofen and diclofenac have GI risks, but generally not as high as piroxicam at typical dosing. Therefore, piroxicam is associated with the greatest GI toxicity among these options.

The risk of gastrointestinal toxicity from NSAIDs is mainly driven by how much the drug inhibits COX-1, which reduces the protective prostaglandins that guard the stomach lining, and by how long the drug stays in the body. Piroxicam is a nonselective NSAID with potent COX-1 inhibition and a relatively long duration of action, so it exposes the gastric mucosa to these harmful effects longer and more strongly. This combination leads to a higher likelihood of gastric ulcers, erosions, and bleeding compared with the others listed. In contrast, celecoxib is COX-2 selective and tends to spare the stomach, reducing GI risk; ibuprofen and diclofenac have GI risks, but generally not as high as piroxicam at typical dosing. Therefore, piroxicam is associated with the greatest GI toxicity among these options.