How do you approach NSAID use in patients on SSRIs?

This is a good question, the combined RR for NSAID+SSRI/GI complications is ~12.

I generally avoid the combination and utilize topical NSAIDs if possible. I also discuss the possibility of switching patients from a 'traditional' SSRI to duloxetine, which is FDA approved for the treatment of primary knee osteoarthritis, and has good anecdotal activity in my patients in other forms of arthritis pain.

If the combination of NSAID and SSRI cannot be avoided, I tend to ensure patients are on a low dos...