Moderate
Acetylsalicylic acid × Prednisolone
Antiplatelet agents (low dose) / NSAIDs (analgesic dose)×Glucocorticoids
Mechanism
Similar to ASA + methylprednisolone. Prednisolone + antiplatelet – additive risk of GI ulcer and bleeding.
Symptoms
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.
Management
For short prednisolone courses, cardioprotective aspirin is acceptable with pantoprazole cover. For prolonged systemic therapy, watch dyspepsia symptoms carefully.