Combination use of nonsteroidal antiinflammatory drugs

Polypharmacy with nonsteroidal antiinflammatory drugs (NSAIDs) is widely practiced despite being condemned by many rheumatologist. Combination use of aspirin with other NSAIDs might be discouraged for three well-documented reasons. First, aspirin reduces the blood levels of many NSAIDs. Second, multiple drugs are antagonistic or at least less than additive in animal models of inflammation. Third, there is no good clinical data to suggest that combination use of NSAIDs is beneficial. Unless new studies become available, NSAIDs should be used one at a time, with supplementary analgesics added on a prn basis.