Aspirin with Ibuprofen Interaction Details

Brand Names Associated with Aspirin

Brand Names Associated with Ibuprofen

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

Interaction Effect

Decreased antiplatelet effect of aspirin, additive risk of bleeding, decreased renal function, and an increased risk of cardiovascular events

Interaction Summary

Concurrent use of analgesic doses of aspirin with ibuprofen is generally not recommended due to an increased risk of bleeding[1] and may also lead to decreased renal function [2]. Due to possible increased risk of cardiovascular events due to the interference of ibuprofen with the antiplatelet effect of aspirin [3], consider use of an NSAID that does not interfere with the antiplatelet effect of aspirin, or non-NSAID analgesics, where appropriate in patients taking low-dose aspirin for cardioprotection. If concomitant use is warranted, administer immediate-release aspirin at least 2 hours [1] before or at least 8 hours after ibuprofen [4]. Administer extended-release aspirin at least 2 to 4 hours before or wait 8 hours after taking ibuprofen [5].

Severity

Major

Onset

Unspecified

Evidence

Probable

How To Manage Interaction

Concurrent use of analgesic doses of aspirin with ibuprofen is generally not recommended due to an increased risk of bleeding[1] and may also lead to decreased renal function [2]. Due to possible increased risk of cardiovascular events due to the interference of ibuprofen with the antiplatelet effect of aspirin [3], consider use of an NSAID that does not interfere with the antiplatelet effect of aspirin, or non-NSAID analgesics where appropriate, in patients taking low-dose aspirin for cardioprotection. If daily aspirin for cardioprotective effects is required in a patient who receives ibuprofen occasionally, administer immediate-release aspirin at least 2 hours [1] before or at least 8 hours after ibuprofen [4]. Administer extended-release aspirin at least 2 to 4 hours before or wait 8 hours after taking ibuprofen [5].

Mechanism Of Interaction

Competition for COX-1 binding site; additive effects on hemostasis; interference with antiplatelet effects

Literature Reports

A) Pharmacodynamic studies have demonstrated interference with the antiplatelet activity of aspirin when ibuprofen (400 mg three times daily) is administered with enteric-coated low-dose aspirin. The interaction exists even following a once-daily regimen of ibuprofen 400 mg, particularly when ibuprofen is dosed prior to aspirin. The interaction is alleviated if immediate-release low-dose aspirin is dosed at least 2 hours prior to a once-daily regimen of ibuprofen; however, this finding cannot be extended to enteric-coated low-dose aspirin [1].

B) Inhibition of platelet aggregation by aspirin was nearly completely abolished when ibuprofen was taken 2 hours before aspirin in healthy subjects in a randomized, crossover study. Subjects received aspirin 81 mg 2 hours before ibuprofen 400 mg daily for 6 days followed by a 14 day washout period, then subjects received the same drugs in reverse order. Acetaminophen, diclofenac, and rofecoxib were similarly studied and did not alter the antiplatelet effect of aspirin. Serum thromboxane B2 and platelet aggregation were inhibited at 24 hours by 99% and 98%, respectively, when aspirin was taken before ibuprofen. In contrast, when ibuprofen was taken before aspirin, serum thromboxane B2 and platelet aggregation were inhibited at 24 hours by 53% and 2%, respectively [6].

C) Concomitant therapy with ibuprofen in patients taking aspirin for cardioprotective effect increased the risk of all-cause mortality in a retrospective cohort study. The study included 7107 patients (age 27 to 100 years) discharged from the hospital with diagnoses of myocardial infarction, angina, stroke or transient ischemic attack, and peripheral vascular disease. Patients had prescriptions for aspirin alone (n=6285), aspirin plus ibuprofen (n=187), aspirin plus diclofenac (n=206), or aspirin and other NSAIDs (n=429). Aspirin doses were less than 325 mg daily, the average ibuprofen dose was 1210 mg daily, and the average diclofenac dose was 117 mg daily. Patients receiving aspirin plus ibuprofen had an increased risk of all-cause mortality and cardiovascular mortality. Patients receiving diclofenac or other NSAIDs did not have an increased risk of mortality. Potential confounders not controlled for in this study included severity of cardiovascular disease, smoking status, body mass index, and doses of individual NSAIDs [7].

D) In an unpublished study, a single ibuprofen 400 mg dose interfered with the antiplatelet activity, as measured by serum thromboxane B2 level, when administered within 30 minutes after immediate-release aspirin 81 mg. The interaction also occurred when a single dose of ibuprofen 400 mg was taken within 8 hours before aspirin dosing [4].

References

1 ) Product Information: DUEXIS(R) oral tablets, ibuprofen famotidine oral tablets. Horizon Pharma USA, Inc. (per FDA), Lake Forest, IL, 2019.

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

3 ) Hohlfeld T , Saxena A , & Schror K : High on treatment platelet reactivity against aspirin by non-steroidal anti-inflammatory drugs--pharmacological mechanisms and clinical relevance. Thromb Haemost 2013; 109(5):825-833.PubMed Abstract: http://www.ncbi.nlm.nih.gov/...

4 ) US Food and Drug Administration: New Information for Healthcare Professionals Concomitant Use of Ibuprofen and Aspirin. US Food and Drug Administration. Rockville, MD. 2006. Available from URL: http://www.fda.go... .

5 ) Product Information: DURLAZA(TM) oral extended release capsules, aspirin oral extended release capsules. New Haven Pharmaceuticals (per manufacturer), North Haven, CT, 2015.

6 ) Catella-Lawson F, Reilly MP, Kapoor SC, et al: Cyclooxygenase inhibitors and the antiplatelet effects of aspirin. New Engl J Med 2001; 345(25):1809-1817.

7 ) MacDonald TM & Wei L: Effect of ibuprofen on cardioprotective effect of aspirin. Lancet 2003; 361(9357):573-574.

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.

Ibuprofen Overview

• Prescription ibuprofen is used to relieve pain, tenderness, swelling, and stiffness caused by osteoarthritis (arthritis caused by a breakdown of the lining of the joints) and rheumatoid arthritis (arthritis caused by swelling of the lining of the joints). It is also used to relieve mild to moderate pain, including menstrual pain (pain that happens before or during a menstrual period). Nonprescription ibuprofen is used to reduce fever and to relieve minor aches and pain from headaches, muscle aches, arthritis, menstrual periods, the common cold, toothaches, and backaches. Ibuprofen is in a class of medications called NSAIDs. It works by stopping the body's production of a substance that causes pain, fever, and inflammation.

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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.