OBJECT DRUGS

Aspirin

PRECIPITANT DRUGS

NSAIDs:

• Ibuprofen (Motrin, etc.)
• Indomethacin (Indocin, etc.)
• Naproxen (Aleve, etc.)

Comment:

Ibuprofen, naproxen, and possibly indomethacin may 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 daily doses, but not when ibuprofen was given as a single dose 2 hours after aspirin. It is likely that the effect of the timing of doses is similar for naproxen and indomethacin. Current evidence suggests that the antiplatelet effect of aspirin is not affected by diclofenac, sulindac or meloxicam. Little is known about the effect of other NSAIDs on the antiplatelet effect of aspirin, but one should assume that some of them probably do interact. 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: Consider using acetaminophen as an alternative if the NSAID is being used as an analgesic. If an NSAID is needed, consider using diclofenac (Voltaren), meloxicam (Mobic), sulindac (Clinoril), or celecoxib (Celebrex). Higher doses of aspirin could also be used without loss of antiplatelet effect.
• Monitor:If the ibuprofen, naproxen or indomethacin is only taken once daily or less, giving the NSAID 2 hours after the aspirin would probably minimize the interaction.