Which pain medications cause gastric ulcers and what to do about it?

By Sina Hartung, MMSC-BMI, Harvard Medical SchoolReviewed by Eureka Health Medical Group
Published: June 13, 2025Updated: June 13, 2025

Summary

Non-steroidal anti-inflammatory drugs (NSAIDs) ‑- such as ibuprofen, naproxen, diclofenac, celecoxib and low-dose aspirin ‑- cause over 90 % of medication-related gastric ulcers by blocking prostaglandins that protect the stomach lining. High-dose oral corticosteroids, the dual antiplatelet combo of aspirin + clopidogrel, and chronic high-dose opioids mixed with alcohol raise ulcer risk further. Combining any NSAID with steroids, SSRIs, or blood thinners multiplies the danger.

Which painkillers are most likely to damage the stomach lining?

NSAIDs are by far the leading culprits, but other analgesics can still harm the stomach when doses climb or drugs are combined. Here is a clear breakdown so you know exactly where the biggest risks lie.

  • Ibuprofen, naproxen and ketoprofen top the over-the-counter risk listAt standard pharmacy strengths (200–220 mg), the 1-year ulcer rate is 1 %; at prescription doses (≥1 600 mg/day) it jumps to 4–5 %.
  • Prescription NSAIDs such as diclofenac, indomethacin and piroxicam carry an even higher bleed rateIndomethacin produces gastric injury in up to 15 % of long-term users within 3 months, says the team at Eureka Health.
  • COX-2 selective drugs like celecoxib lower but don’t eliminate ulcer riskCelecoxib halves ulcer incidence versus naproxen but still causes endoscopic ulcers in 2 % of users after 6 months.
  • Low-dose aspirin (75–325 mg) causes silent ulcersAbout 10 % of chronic aspirin users develop an ulcer visible on scope without any warning pain, according to Sina Hartung, MMSC-BMI.
  • High-dose systemic steroids magnify NSAID injuryPrednisone ≥20 mg/day alone raises ulcer odds two-fold; combined with ibuprofen the risk is five-fold.
  • High-dose, long-term NSAID therapy produces ulcers in up to one in five patientsAbout 15 % of people treated chronically with NSAIDs develop peptic ulcers detected on endoscopy, highlighting how duration and dose amplify stomach damage. (MedicineNet)
  • H. pylori infection multiplies the chance of NSAID-related ulcer complicationsKaiser Permanente notes that regular NSAID users who also harbor H. pylori face a markedly higher risk of serious ulcer bleeding or perforation than those with either risk factor alone. (Kaiser)

References

When is stomach pain from pain meds an emergency?

An ulcer can bleed or perforate with little warning. Knowing the red-flag signs allows you to act before irreversible damage occurs.

  • Sudden, sharp epigastric pain radiating to the backA perforation demands immediate surgery; call 911 if pain feels "like a knife through" the abdomen.
  • Black, tarry stools (melena) signal upper GI bleedingOne tablespoon of blood can darken stool; don’t wait for dizziness or fainting.
  • Vomiting coffee-ground material or bright-red bloodEven a few teaspoons of hematemesis warrant ED care—mortality from massive NSAID bleeds can reach 10 %.
  • Drop in blood pressure or heart rate over 100The team at Eureka Health warns that systolic BP below 100 mmHg plus tachycardia points to significant blood loss.
  • Unexplained fatigue and shortness of breathChronic micro-bleeds cause iron-deficiency anemia; hemoglobin under 10 g/dL should be treated urgently.
  • Persistent nausea, loss of appetite, or unexplained weight loss require urgent evaluationWebMD cautions that these symptoms during NSAID use can indicate a bleeding or obstructing ulcer that needs immediate medical attention. (WebMD)
  • About 15 % of long-term NSAID users develop peptic ulcersMedicineNet reports that roughly one in seven people on chronic NSAID therapy form an ulcer, so any new abdominal pain while on these drugs should be treated seriously. (MedNet)

References

Who is at highest risk of an ulcer from these drugs?

Not everyone reacts the same way to a given dose. Certain medical histories and lifestyle factors multiply gastric injury.

  • Adults over 60 have triple the bleeding rateAge-related decline in mucosal blood flow weakens stomach defenses.
  • Prior ulcer or H. pylori infection raises recurrence to 20 % in one yearSina Hartung, MMSC-BMI, notes that eradicating H. pylori before restarting NSAIDs cuts this risk in half.
  • Concurrent use of SSRIs, anticoagulants or steroids doubles ulcer oddsSertraline or warfarin plus naproxen increase bleeding probability by 3-fold compared with NSAID alone.
  • Smoking and drinking over two alcoholic drinks dailyNicotine and ethanol both impair prostaglandin synthesis, weakening gastric mucus.
  • Chronic kidney disease or cirrhosis complicates healingThese conditions prolong bleeding times and slow mucosal repair.
  • Up to one in five people on high-dose NSAIDs develop ulcer-like soresKaiser Permanente notes that about 15–20 % of patients taking high doses of NSAIDs form gastric or duodenal lesions during therapy. (KP)
  • NSAID stomach bleeding leads to over 100,000 U.S. hospitalizations annuallyGastroenterology Specialties reports that serious NSAID-related GI events cause more than 100,000 hospital admissions and thousands of deaths each year. (GIDocs)

References

How can I relieve pain without hurting my stomach?

Many people can control pain while protecting their gut by adjusting dose, timing, and co-medication. Here are evidence-based steps you can take today.

  • Use the lowest effective NSAID dose for the shortest timeThree days of 400 mg ibuprofen every 8 hours carries far less risk than 800 mg for two weeks.
  • Take NSAIDs with a full meal or 240 mL of milkFood delays drug absorption, reducing peak gastric concentration by roughly 30 %.
  • Add a proton-pump inhibitor (PPI) if you need daily NSAIDsOmeprazole 20 mg lowered ulcer incidence from 20 % to 4 % in the OMNIUM trial, the team at Eureka Health explains.
  • Consider acetaminophen up to 3 000 mg/day for milder painIt has negligible ulcer risk but watch total dose to avoid liver damage.
  • Incorporate non-drug options like physiotherapy or topical diclofenac gelTopicals deliver only 6 % systemic exposure, slashing GI events.
  • Up to 15 % of chronic NSAID users develop a peptic ulcerMedicineNet reports that about 15 % of patients on long-term NSAID therapy will form an ulcer, underscoring the importance of limiting duration. (MedicineNet)
  • After gastric bypass, avoid NSAIDs for at least six weeksBariatric guidance notes the surgically altered stomach is so vulnerable that NSAIDs should be avoided for the first six weeks post-operation and used only rarely thereafter with acid suppression. (AnthonyClough)

References

What tests and prescriptions can identify and treat drug-induced ulcers?

Objective data guide safe treatment and healing. Your clinician can order the following investigations and medications.

  • Upper endoscopy remains the gold standardIt visualizes and cauterizes active bleeds with a >90 % success rate.
  • H. pylori stool antigen or breath testEradication cures 80 % of NSAID-related ulcers when combined with PPI therapy.
  • Complete blood count (CBC) and ferritinDetect occult blood loss early; hemoglobin drop of 2 g/dL signals significant bleed.
  • High-dose PPI therapy for eight weeksPantoprazole 40 mg twice daily heals 95 % of uncomplicated ulcers, says Sina Hartung, MMSC-BMI.
  • Misoprostol 200 µg four times daily for refractory casesMisoprostol replaces lost prostaglandins but causes diarrhea in 13 % of patients.
  • Up to 20% of chronic NSAID users develop peptic ulcersPopulation data show that 15–20 % of patients taking high-dose or long-term NSAIDs will develop endoscopically confirmed ulcers, underscoring the need for screening and gastro-protective therapy. (KP)
  • Daily proton pump inhibitor co-therapy is the most effective ulcer prophylaxisAustralian Prescriber advises adding a once-daily PPI to every NSAID regimen because it is the single most effective measure to lower NSAID-related ulcer risk, outperforming H2 blockers or COX-2 switching. (AP)

References

How Eureka’s AI doctor spots ulcer risk early

Eureka’s symptom-checker cross-references your medication list, medical history, and reported stomach symptoms in seconds, flagging dangerous drug combinations.

  • Real-time NSAID-interaction alertsIf you log ibuprofen and prednisone, Eureka prompts a risk score and suggests adding a PPI.
  • Personalized red-flag remindersThe app notifies you if you enter "black stool" or "coffee-ground vomit," advising immediate ER care, the team at Eureka Health notes.
  • Trend tracking of hemoglobin and ferritinUpload lab results and Eureka graphs changes, highlighting any downward trend.

Using Eureka to stay ulcer-free while treating pain

Thousands of users rely on Eureka to balance pain relief with stomach safety. Women using Eureka for menopause-related joint pain rate the app 4.8 out of 5 stars.

  • Request labs or a PPI without a waiting roomEureka’s AI drafts the order; a board-certified physician reviews and signs if appropriate.
  • Set refill reminders that respect safe dosing limitsIf you try to refill naproxen too soon, Eureka asks follow-up questions first.
  • Private, on-demand conversationsAll chats are encrypted, and the AI answers 24/7 without judgment.
  • Actionable care plans you can print or sharePlans include taper schedules, diet tips, and alarm symptoms to watch for, based on your profile.

Become your own doctor

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Frequently Asked Questions

Is acetaminophen completely safe for my stomach?

It rarely causes ulcers but can harm the liver above 4 000 mg per day or with heavy alcohol use.

Can I drink coffee while taking ibuprofen?

Yes, but caffeine may worsen reflux; it does not directly increase ulcer risk.

Does enteric-coated aspirin prevent ulcers?

It delays release to the intestine but still exposes the stomach to absorbed aspirin in the bloodstream, so ulcers can still form.

How long after stopping NSAIDs will my ulcer heal?

With a PPI, most uncomplicated ulcers close in 6–8 weeks; deeper lesions may need 12 weeks.

Are topical NSAID creams truly safer?

They reduce systemic exposure by about 90 %, making gastric ulcers extremely uncommon.

Should I test for H. pylori before starting long-term naproxen?

Yes, eradication lowers ulcer risk, especially if you have a prior GI history or are over 60.

Can I take celecoxib if I have heart disease risk?

COX-2 inhibitors slightly raise blood-clot risk; discuss alternatives or add aspirin under medical supervision.

Do probiotics help prevent NSAID ulcers?

Evidence is limited; they may ease dyspepsia but do not replace PPIs or dose reduction.

This content is for informational purposes only and is not intended as medical advice. Always consult with a qualified healthcare provider for diagnosis, treatment, and personalized medical recommendations.

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