Acetylsalicylic acid × Dexamethasone

Additive ulcerogenic effect. Dexamethasone suppresses GI mucosal repair; aspirin blocks protective prostaglandins.

Epigastric pain, nausea, heartburn. With prolonged therapy: peptic ulcer and GI bleeding risk (black stools, vomiting blood or coffee-ground material). Older patients and prior peptic ulcer disease: higher risk.

For short dexamethasone courses, cardioprotective aspirin is acceptable with pantoprazole cover. For prolonged systemic glucocorticoid therapy, watch dyspepsia symptoms; consider stool occult blood testing as needed.