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Therefore, whenever use of relatively high dosages within the recommended dosage range is considered, sufficient benefit to offset the potential increased risk of GI toxicity should be anticipated. In addition to a history of ulcer disease, pharmacoepidemiologic studies have identified several comorbid conditions and concomitant therapies that may increase the risk for GI bleeding, including concomitant use of oral corticosteroids or anticoagulants, longer duration of NSAIA therapy, smoking, alcoholism, older age, and poor general health status. Patients with rheumatoid arthritis are more likely to experience serious GI complications from NSAIA therapy than are patients with osteoarthritis. In addition, geriatric or debilitated patients appear to tolerate GI ulceration and bleeding less well than other individuals, and most spontaneous reports of fatal GI effects have been in such patients. In one study, therapy with high dosages of famotidine 40 mg twice daily was more effective than placebo in preventing peptic ulcers in NSAIA-treated patients; however, the effect of the drug was modest. In addition, efficacy of usual dosages of H 2 -receptor antagonists for the prevention of NSAIA-induced gastric and duodenal ulcers has not been established.

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