Interactions between ibuprofen and Bayer aspirin sugar free (aspirin)
ibuprofen and aspirin (Major Drug-Drug)
GENERALLY AVOID: The antiplatelet and cardioprotective effect of low-dose aspirin may be antagonized by prior administration (within 2 hours) or multiple daily doses of some nonsteroidal anti-inflammatory drugs (NSAIDs). Ibuprofen has been specifically implicated, and there is evidence that indomethacin may also. The mechanism of interaction is competitive inhibition of platelet cyclooxygenase by certain NSAIDs, which, unlike aspirin, bind reversibly at the active site of the enzyme and cause a temporary rather than sustained depression of thromboxane formation and thromboxane-dependent platelet function. A retrospective study of 7107 heart patients discharged from hospitals between 1989 and 1997 with aspirin prescriptions found that those also taking ibuprofen were twice as likely to die during the study period as those taking aspirin alone or with other NSAIDs or acetaminophen. That translates to 12 extra deaths (3 heart-related deaths) a year for every 1000 patients treated. The combined use of aspirin with NSAIDs in general may also increase the potential for serious gastrointestinal (GI) toxicity, including inflammation, bleeding, ulceration, and perforation. Pharmacokinetically, aspirin at anti-inflammatory dosages or higher has been shown to decrease the plasma concentrations of many NSAIDs. However, the therapeutic response does not appear to be affected.
MANAGEMENT: Patients receiving low-dose aspirin for cardioprotective effects should avoid the regular use of ibuprofen and possibly indomethacin. Occasional, single doses of these agents may be given but should not be administered simultaneously or within 2 hours prior to the aspirin dose. If routine NSAID therapy is necessary, diclofenac may be a viable alternative. In the study implicating ibuprofen, 75 mg twice daily of delayed-release diclofenac did not interfere with the antiplatelet activity of aspirin. In any case, caution is advised whenever aspirin is combined with a NSAID due to the potential for additive GI toxicity. Patients should be advised to take the medications with food and to immediately report signs and symptoms of GI ulceration and bleeding such as severe abdominal pain, dizziness, lightheadedness, and the appearance of black, tarry stools.
