In these patients, reversible renal insufficiency occurred after several days of combination therapy. These symptoms correlate poorly with the degree of mucosal injury. When feasible, monitor stool for blood loss. During chronic administration, more serious effects, such as peptic ulcer disease and gastritis, leading to GI bleeding or even perforation can occur at any time, with or without warning. These effects can be potentiated by alcohol and smoking.
Vision generally improves when the drug is discontinued.
The mechanism for visual disturbances is unclear. Other changes in the special senses include tinnitus and hearing loss. It is well known that vasodilatory renal prostaglandins and the potent vasoconstrictor angiotensin II work in concert to maintain renal blood flow. This problem can be manifest as hyperkalemia, hyperuricemia, or azotemia. Usually, this is an infrequent occurrence, but patients should be monitored closely if elevated hepatic enzymes are observed during therapy.