Major
Diclofenac × Prednisolone
Non-steroidal anti-inflammatory drugs (NSAIDs)×Glucocorticoids
Mechanism
Similar to ibuprofen – additive GI bleeding risk. Diclofenac has a higher ulcerogenic potential among NSAIDs.
Symptoms
Black or tarry stools (melena), vomiting blood or coffee-ground material, epigastric pain. Risk multiplies in older patients and with prior peptic ulcer disease.
Management
Avoid prolonged combination. If diclofenac is needed, use the minimum effective dose for 5–7 days with mandatory pantoprazole cover. For chronic analgesia: paracetamol or celecoxib.