Luis Bujanda
Digestive specialist and Professor of Medicine at the University of the Basque Country (UPV/EHU)
NSAIDs are one of the most prescribed pharmacological groups in Spain for different reasons, especially for osteoarticular disorders, but also for other types of pain such as menstruation. Moreover, it is well known that NSAIDs are the main cause of upper and lower gastrointestinal bleeding, as well as other complications such as intestinal perforations. It is also known how, when associated with other drugs such as corticosteroids or anticoagulants, the negative effects on the gut are significantly increased.
Ibuprofen is the most widely marketed non-steroidal anti-inflammatory drug in Spain and the combination with codeine is very rare. Moreover, so far it has not been shown that the combination of ibuprofen and codeine significantly increases the risk of intestinal complications, and less severe ones. This is probably also due to the fact that this combination is rarely prescribed in the population, but so far there is no data to say that the risk of gastrointestinal complications is increased by the ibuprofen-codeine combination.
From a digestive point of view, we do advise restricting the use of anti-inflammatory drugs whenever necessary and taking care in at-risk populations due to the risk of gastrointestinal complications in general. For example, people of advanced age, with a lot of medication, with a peptic ulcer in the past.... These other types of complications may increase the risk of new gastrointestinal complications in these individuals.
It should also be added that there is currently an overdosage of proton pump inhibitors (omeprazole and many others, taken by 25% of the population) in an attempt to counteract this effect, which is often unjustified.