OBJECT DRUGS

• Aspirin

PRECIPITANT DRUGS

• Ibuprofen

Comment:

Ibuprofen has been shown to interfere with the ability of aspirin to inhibit platelet aggregation, and some evidence suggests that this may also inhibit the cardioprotective effect of aspirin. The effect was seen when ibuprofen was given 2 hours before aspirin, and when ibuprofen was given in multiple doses. No effect on aspirin's antiplatelet effect was seen with a single ibuprofen dose 2 hours after the aspirin. Current evidence suggests that the antiplatelet effect of aspirin is not affected by diclofenac, and preliminary data suggest that the effect of other NSAIDs on aspirin is limited. Celecoxib (and probably other COX-2 inhibitors) and acetaminophen do not affect platelet function or the antiplatelet effect of aspirin.

Class 3: Assess Risk & Take Action if Necessary

• Consider Alternative: Acetaminophen could be used as an analgesic in place of a NSAID. Consider using diclofenac (Voltaren) or a COX-2 inhibitor as an alternative anti-inflammatory agent. Higher analgesic doses of aspirin could be used without loss of antiplatelet effect. Until further data are available, one must consider the possibility that other NSAIDs could inhibit the antiplatelet effect of aspirin.
• Circumvent/Minimize: If the ibuprofen is only taken once daily, giving it 2 hours after the aspirin appears to minimize the interaction.