Aspirin with Dipyrone Interaction Details

Brand Names Associated with Aspirin

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Mar 04, 2024

Interaction Effect

Reduced efficacy of aspirin, an increased risk of bleeding, and decreased renal function

Interaction Summary

Concurrent use of aspirin with dipyrone (an NSAID) is generally not recommended due to an increased risk of bleeding and may also lead to decreased renal function[1]. Use dipyrone with caution in patients taking aspirin for secondary cardiovascular prevention. Mortality and major adverse cardiac and cerebrovascular events were significantly increased with aspirin plus dipyrone therapy versus aspirin alone as secondary prophylaxis in patients with a cardiovascular event in a large cohort study [2]. The antiplatelet efficacy of low-dose aspirin may be reduced when used concomitantly with dipyrone. Residual platelet reactivity (aggregation greater than 0%) and high on-treatment reactivity (aggregation greater than 20%) occurred in significantly more patients with stroke or TIA receiving concomitant low-dose aspirin and dipyrone versus aspirin alone [3]. Significant differences were also observed for platelet aggregation and thromboxane formation in a study in patients with stable cardiovascular, cerebrovascular, or peripheral arterial disease who received low-dose aspirin with at least 5 days of dipyrone [4]. Neurological recovery at 3 months was also significantly reduced in the stroke/TIA patients with concomitant use [3].

Severity

Major

Onset

Unspecified

Evidence

Established

How To Manage Interaction

Concurrent use of aspirin with dipyrone (a NSAID) is generally not recommended due to an increased risk of bleeding and may also lead to decreased renal function[1]. Use dipyrone with caution in patients taking aspirin for secondary cardiovascular prevention. Mortality and major adverse cardiac and cerebrovascular events were significantly increased with aspirin plus dipyrone therapy versus aspirin alone as secondary prophylaxis in patients with a cardiovascular event in a large cohort study [2]. The antiplatelet efficacy of low-dose aspirin may be reduced when used concomitantly with dipyrone [4][3].

Mechanism Of Interaction

Attenuated antiplatelet effect of aspirin; additive anticoagulant effects

Literature Reports

A) A retrospective propensity-score adjusted cohort study compared mortality events in patients with a cardiovascular event who received secondary prophylaxis with aspirin only (n=26,200) or aspirin plus dipyrone (n=5946) and followed them for 36 months. Compared with aspirin alone, aspirin plus dipyrone therapy significantly increased all cause mortality (24.4% vs 15.6%; HR, 1.66; 95% CI, 1.56 to 1.76; number needed to harm [NNH], 11), major adverse cardiac and cerebrovascular events (mortality, stroke, or myocardial infarction; 33.9% vs 24.9%; HR, 1.45; 95% CI, 1.38 to 1.53; NNH, 11.15), myocardial infarction (5.9% vs 5.2%; HR, 1.18; 95% CI, 1.05 to 1.32; NNH, 140), and stroke/TIA (8.5% vs 7.3%; HR, 1.22; 95% CI, 1.11 to 1.35; NNH, 82); there was no significant difference in bleeding events (0.6% vs 0.4%). The mean age was 72 years in the aspirin only group and 70 years in the aspirin plus dipyrone group; and 56.4% and 56.7% were men. The aspirin dosage was 75 to 100 mg/day, and the mean dipyrone dosage was 2.06 mg/day [2].

B) Complete inhibition of arachidonic acid-induced platelet aggregation was achieved in significantly fewer patients with stable cardiovascular, cerebrovascular, or peripheral arterial disease who were receiving long-term low-dose aspirin (100 mg/day) with dipyrone 1500 to 4000 mg/day for at least 5 days (n=27) compared with patients who received aspirin 100 mg/day without dipyrone (n=10) in a case-control study (22% vs 90%). Thromboxane formation was significantly greater in the aspirin plus dipyrone group versus aspirin alone (387 vs 7 nanograms/mL) [4].

C) Residual platelet reactivity (aggregation greater than 0%) occurred in a significantly greater proportion of patients who received concomitant dipyrone (for 3 days or longer) plus low-dose aspirin (100 mg/day) compared with low-dose aspirin alone (67% vs 10%) in a cohort study in patients post acute stroke or transient ischemic attack (N=41). High on-treatment platelet reactivity (maximum aggregation greater than 20%) occurred in 0% with aspirin alone versus 33% with dipyrone plus aspirin, a significant difference. Excellent neurological recovery, defined as a modified Rankin scale of less than 2 at 3 months after stroke onset, was observed in a significantly greater proportion of patients who received aspirin alone versus those with the concomitant therapy (80% vs 48%) [3].

References

1 ) Product Information: CARISOPRODOL, ASPIRIN, CODEINE PHOSPHATE oral tablets, carisoprodol, aspirin, codeine phosphate oral tablets. Ingenus Pharmaceuticals LLC (per DailyMed), Orlando, FL, 2021.

2 ) Polzin A, Dannenberg L, Helten C, et al: Excess mortality in aspirin and Dipyrone (metamizole) co-medicated in patients with cardiovascular disease: a nationwide study. J Am Heart Assoc 2021; 10(22):e022299-.PubMed Abstract: http://www.ncbi.nlm.nih.gov/...

3 ) Dannenberg L, Erschoff V, Bonner F, et al: Dipyrone comedication in aspirin treated stroke patients impairs outcome. Vascul Pharmacol 2016; 87:66-69.PubMed Abstract: http://www.ncbi.nlm.nih.gov/...

4 ) Schmitz A, Romann L, Kienbaum P, et al: Dipyrone (metamizole) markedly interferes with platelet inhibition by aspirin in patients with acute and chronic pain: a case-control study. Eur J Anaesthesiol 2017; 34(5):288-296.PubMed Abstract: http://www.ncbi.nlm.nih.gov/...

Aspirin Overview

• Prescription aspirin is used to relieve the symptoms of rheumatoid arthritis (arthritis caused by swelling of the lining of the joints), osteoarthritis (arthritis caused by breakdown of the lining of the joints), systemic lupus erythematosus (condition in which the immune system attacks the joints and organs and causes pain and swelling) and certain other rheumatologic conditions (conditions in which the immune system attacks parts of the body). Nonprescription aspirin is used to reduce fever and to relieve mild to moderate pain from headaches, menstrual periods, arthritis, toothaches, and muscle aches. Nonprescription aspirin is also used to prevent heart attacks in people who have had a heart attack in the past or who have angina (chest pain that occurs when the heart does not get enough oxygen). Nonprescription aspirin is also used to reduce the risk of death in people who are experiencing or who have recently experienced a heart attack. Nonprescription aspirin is also used to prevent ischemic strokes (strokes that occur when a blood clot blocks the flow of blood to the brain) or mini-strokes (strokes that occur when the flow of blood to the brain is blocked for a short time) in people who have had this type of stroke or mini-stroke in the past. Aspirin will not prevent hemorrhagic strokes (strokes caused by bleeding in the brain). Aspirin is in a group of medications called salicylates. It works by stopping the production of certain natural substances that cause fever, pain, swelling, and blood clots.

• Aspirin is also available in combination with other medications such as antacids, pain relievers, and cough and cold medications. This monograph only includes information about the use of aspirin alone. If you are taking a combination product, read the information on the package or prescription label or ask your doctor or pharmacist for more information.

Return To Our Drug Interaction Homepage

Feedback, Question Or Comment About This Information?

Definitions

Severity Categories

Contraindicated

These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.

Major

This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.

Moderate

This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.

Minor

While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.

Onset

Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.

Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.

Evidence

Level of documentation of the interaction.

Established: The interaction is documented and substantiated in peer-reviewed medical literature.

Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.

How To Manage The Interaction

Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.

It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.

Mechanism Of Interaction

The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.

Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.

Where Does Our Information Come From?

Information for our drug interactions is compiled from several drug compendia, including:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

The prescribing information for each drug, as published on DailyMED, is also used. 

Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.

The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.