Which NSAID would you expect to have the least GI side effects?

Which NSAID would you expect to have the least GI side effects?

• A. Aspirin
• B. Indomethacin
• C. Celecoxib
• D. Naproxen sodium

Answer: (C)

GI irritation from NSAIDs mainly comes from blocking COX-1, which protects the stomach by maintaining the mucous layer and normal mucosal blood flow. A drug that selectively inhibits COX-2, like celecoxib, reduces inflammation while sparing COX-1 activity, so it tends to cause fewer GI side effects such as dyspepsia, gastritis, ulcers, and bleeding. The other options are nonselective COX inhibitors, which inhibit both COX-1 and COX-2 and thus carry higher GI risk—aspirin is notably irritant and bleeding-prone, indomethacin has strong GI ulcer potential, and naproxen also increases GI side effects compared with COX-2 selective agents. Therefore celecoxib would be expected to have the least GI side effects.

GI irritation from NSAIDs mainly comes from blocking COX-1, which protects the stomach by maintaining the mucous layer and normal mucosal blood flow. A drug that selectively inhibits COX-2, like celecoxib, reduces inflammation while sparing COX-1 activity, so it tends to cause fewer GI side effects such as dyspepsia, gastritis, ulcers, and bleeding. The other options are nonselective COX inhibitors, which inhibit both COX-1 and COX-2 and thus carry higher GI risk—aspirin is notably irritant and bleeding-prone, indomethacin has strong GI ulcer potential, and naproxen also increases GI side effects compared with COX-2 selective agents. Therefore celecoxib would be expected to have the least GI side effects.