Acetylsalicylic acid × methylprednisolone

Glucocorticoids damage the gastric mucosa and suppress protective prostaglandin production. Aspirin compounds the risk of GI ulcer and bleeding.

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

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