Aspirin with Sodium Bicarbonate Interaction Details

Brand Names Associated with Aspirin

Brand Names Associated with Sodium Bicarbonate

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

Interaction Effect

Decreased salicylate effectiveness

Interaction Summary

Routine administration of aluminum, calcium or magnesium containing products has been reported to increase urinary pH significantly enough to increase the renal elimination of salicylates, decreasing salicylate concentrations by 30 to 70%[1][2].

Severity

Moderate

Onset

Delayed

Evidence

Theoretical

How To Manage Interaction

Monitor for reduced aspirin effectiveness upon initiation of aluminum, calcium or magnesium containing products or for possible aspirin toxicity upon withdrawal of aluminum, calcium or magnesium containing products. Adjust the dose accordingly. Suggest using buffered aspirin to limit the degree to which the urine is alkalinized.

Mechanism Of Interaction

Increased renal clearance and decreased absorption (due to increased urinary pH)

Literature Reports

A) Concomitant aspirin and antacid therapy has been reported to result in lowering of serum salicylate levels, either secondary to a decrease in renal tubular reabsorption of salicylate or increasing gastric emptying of enteric coated tablets causing earlier or more rapid release of aspirin in the intestine [3][4][5][6].

B) In a pilot study with 5 uremic patients, aluminum-magnesium and calcium antacids were shown to decrease aspirin absorption. Salicylate serum levels were lowest if aspirin was given 2 hours after antacid ingestion compared to salicylate levels achieved after simultaneous administration. Maximum salicylate levels were reduced by 50% to 70% by administration of antacids [7].

References

1 ) Gibaldi M, Grundhofer B, & Levy G: Effect of antacids on pH of urine. Clin Pharmacol Ther 1974; 16:520-525.

2 ) Hansten PD & Hayton WL: Effect of antacid and ascorbic acid on serum salicylate concentration. J Clin Pharmacol 1980; 20:326-331.

3 ) Feldman S & Carlstedt BC: Effects of antacid on absorption of enteric-coated aspirin. JAMA 1974; 227:660.

4 ) Levy G, Lampman T, Kamath BL, et al: Decreased serum salicylate concentrations in children with rheumatic fever treated with antacids. N Engl J Med 1975; 293:323.

5 ) Strickland-Hodge B, Thomas TR, Gould WA, et al: The effects of antacids on enteric-coated salicylate preparations. Rheumatol Rehabil 1976; 15:148-152.

6 ) Shastri RA: Effect of antacids on salicylate kinetics. Int J Clin Pharmacol Ther Toxicol 1985; 23:480-484.

7 ) Gaspari F, Vigano G, Tocatelli M, et al: Influence of antacid administrations on aspirin absorption in patients with chronic renal failure on maintenance hemodialysis. Am J Kidney Dis 1988; 11:338-342.

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.

Sodium Bicarbonate Overview

• Sodium bicarbonate is an antacid used to relieve heartburn and acid indigestion. Your doctor also may prescribe sodium bicarbonate to make your blood or urine less acidic in certain conditions.

• This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

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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.