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If oral ibuprofen is necessary , consider these risk-reduction strategies: Use the lowest effective dose (200-400 mg) for the shortest duration possible Take ibuprofen with or after food to minimise gastric irritation (ensuring this is at least 30 minutes after taking Rybelsus) Consider gastroprotection with a proton pump inhibitor (PPI) if you have risk factors for gastric complications, including: age 65, history of peptic ulcer or GI bleeding, concurrent use of anticoagulants, antiplatelets, SSRIs/SNRIs, or corticosteroids [13] [14] Avoid prolonged courses without medical supervision Do not take ibuprofen if you are dehydrated or experiencing vomiting or diarrhoea Alternative analgesics may include codeine-based preparations for more severe pain, though these can cause constipation and nausea, potentially compounding Rybelsus side effects

Fondaparinux (antithrombin activator) and the direct thrombin inhibitor drugs including hirudin and bivalirudin significantly inhibited procoagulant activity of hepatocytes in vitro (Stephenne et al., 2012)