Question: Low-Dose Aspirin and NSAIDs - A Safe Combination?
Many patients are prescribed low-dose aspirin as a cardioprotective treatment but they are already taking an NSAID to treat arthritis. Is it safe to take both? Is there any action that should be taken, such as not taking them together, to ensure safe use? Should lab tests be routinely performed to monitor the kidneys or liver? Or, is it a perfectly safe combination, and no worries?
Potential Drug Interactions Between Low-Dose Aspirin and NSAIDsMany patients taking low-dose aspirin for cardioprotective benefit are also prescribed NSAIDs such as ibuprofen to treat their arthritis pain. There are two potential drug interactions between aspirin and the NSAIDs. First, both can increase the risk of bleeding, including bleeding ulcers -- a potential life-threatening complication. It is more likely to occur in patients who have other risk factors for ulcers including:
- advanced age (over 65)
- already taking corticosteroids
- already taking blood thinners such as coumadin or Plavix
- excessive alcohol intake
- those with a prior history of ulcers or gastrointestinal bleeding
Proton Pump Inhibitors Can Decrease Risks
According to rheumatologist Scott J. Zashin, MD, "One way to help decrease the risk when both medications are recommended is to add a proton pump inhibitor such as Prilosec, Nexium, Prevacid or Aciphex. These stomach protectors are best taken on an empty stomach 30 minutes prior to the first meal of the day to get maximum benefit."
Certain NSAIDs Less Likely to Cause Bleeding
Zashin continued, "Some anti-inflammatories such as Salsalte (a non-acetylated aspirin), low dose Celebrex, diclofenac (Voltaren) and meloxicam (Mobic) may be less likely to cause bleeding. Another interaction is that some NSAIDs interfere with the anti-platelet effect of aspirin (which is how it helps prevent stroke or heart attack). Studies have shown that ibuprofen appears to alter the anti-platelet effect of aspirin -- but diclofenac, meloxicam and Celebrex do not."
Other Treatment Options
Other options to treat arthritis pain in patients on low-dose aspirin, rather than NSAIDs, include analgesics (e.g., Tylenol or tramadol). In addition, for localized areas of pain, patients may consider over-the-counter topical creams or gels that provide a hot or cold feeling to distract (counterirritant) the pain. Wraps that provide cold or heat the hand, elbow, knee, neck and shoulder are also options.
Monitoring Patients on Low-Dose Aspirin and an NSAID
Zashin continued, "Monitoring patients taking NSAIDs in combination with low-dose aspirin is the same as those on NSAIDs alone. I typically will check a blood count (for anemia) and chemistry (liver and kidney function) 2 to 3 weeks after starting treatment then again in 8 to 10 weeks and every 3 to 6 months based on the individual patient."
Dr. Zashin is clinical assistant professor at University of Texas Southwestern Medical School and an attending physician at Presbyterian Hospitals of Dallas and Plano. Dr. Zashin is author of Arthritis Without Pain - The Miracle Of TNF Blockers. The book is useful for anyone on one of the biologic drugs or considering the biologic drugs.