How to take your daily aspirin if you also use an NSAID - non-steroidal anti-inflammitory such as ibuprofen

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If you use pain relievers and have been asked by your doctor to take daily aspirin for your heart or to prevent stroke, the FDA has some important news for you. They've found that aspirin may not help you if you take it at the same time as one of the most common pain killers available over-the-counter, ibuprofen. Ibuprofen goes by the brand names of Advil or Motrin, and are in the class of pain relieving medicines called non-steroidal anti-inflammatory drugs (NSAID) which include many others.

Here's the short story:
- take your daily dose of immediate-release low dose aspirin at least 30 minutes before you ever take ibuprofen and possibly any non-steroidal anti-inflammatory drug (NSAID).
- Otherwise, you should wait at least 8 hours after taking a dose of ibuprofen before taking your daily aspirin dose, in order to avoid preventing the heart-protecting anti-platelet effects of aspirin.

The long story is based on lab research that's a bit complicated. Here's what they found. These findings were based on lab research, which means that they didn't compare how people did who took aspirin together with ibuprofen to people who took them at different times. That kind of research provides the best evidence, since you then know that something bad happened to real people when they took the medications together -- but they didn't do that. The reason the FDA is sharing this information is that it's the first in a series of alerts they intend to give bringing attention to the striking lab research they've done on using these drugs together which has widespread importance, given how many people take these drugs together.

The details of what happens has to do with platelets. Platelets are cells in your blood that allow your blood to clot. Aspirin decreases their stickiness and lessens the chance you'll have a heart attack since part of the blockage of heart arteries is by these platelets. When taking both of these drugs, competitive inhibition takes place between aspirin and NSAIDs for the platelet cyclooxygenase (COX) acetylation site. That means that both drugs are trying to attach themselves to the same spot on a platelet and they both won't fit, only one of them. Aspirin produces its anti-platelet effect by irreversibly acetylating cyclooxygenase that lasts the entire 7 day life of the platelet. That means that aspirin works by sticking to platelets for their whole 1 week lifespan. Ibuprofen and other NSAIDs reversibly bind cyclooxygenase at a nearby site and can physically block aspirin's ability to bind to its active site. They both don't fit, aspirin and NSAIDs. This interference of the heart-protective effect can be avoided by allowing aspirin to arrive to the site before the NSAID. This is the reason for the timing of taking the 2 drugs if you choose to.

Whew. So, if your doctor asks you to, it is safe to take both drugs, minding the timing of when you take them. This is going to be huge news to many people, and watch out for more information as this trickles out.

Many articles at Google News are talking about this...
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About the Author


MD, FACP, FASN

Dr. Schwimmer's blog explores the intersection of medicine, new technologies, and the Internet.

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