What medications relieve stomach discomfort from Aspirin (Acetylsalicylic Acid)?

From the Guidelines

To relieve stomach discomfort from ASA, proton pump inhibitors (PPIs) like omeprazole 20mg daily are recommended for ongoing use, as they are more potent options in minimizing gastrointestinal bleeding, especially when ASA is used concomitantly with other anticoagulants 1. When considering the relief of stomach discomfort from ASA, several options are available, including antacids, H2 blockers, and PPIs.

• Antacids like Tums or Rolaids can provide quick relief by neutralizing stomach acid.
• H2 blockers such as famotidine (Pepcid) at 20mg or ranitidine (Zantac) at 150mg taken 30 minutes before ASA can reduce acid production, with studies showing a modest protective effect in patients taking aspirin 1.
• However, PPIs are considered more effective in preventing upper GI bleeding, especially in patients with elevated cardiovascular risk or those taking concomitant medications like warfarin or steroids 1. Taking ASA with food or using enteric-coated aspirin formulations can also help minimize irritation.
• For immediate relief of existing discomfort, liquid antacids work fastest.
• If using ASA regularly, consider taking it with a full glass of water and staying upright for 30 minutes afterward to reduce the risk of gastrointestinal complications. It's essential to note that if stomach pain persists despite these measures, consulting a healthcare provider is crucial, as this could indicate ulceration or other complications.
• The choice of medication should be based on individual patient factors, including age, previous gastrointestinal events, and concomitant medication use, with PPIs being a preferred option for those at higher risk of gastrointestinal bleeding 1.

From the FDA Drug Label

Misoprostol has been shown to reduce the risk of gastric ulcers in controlled studies of 3 months’ duration. It had no effect, compared to placebo, on gastrointestinal pain or discomfort associated with NSAID use. In these trials there were no significant differences between misoprostol and placebo in relief of day or night abdominal pain.

Medication does not relieve stomach discomfort from Asa.

• The medication misoprostol reduces the risk of gastric ulcers, but
• It does not reduce gastrointestinal pain or discomfort associated with NSAID use, including aspirin 2, 2.

From the Research

Medication to Relieve Stomach Discomfort from Asa

• Aspirin can cause stomach discomfort due to its gastrointestinal effects, including mucosal damage in the upper and lower gastrointestinal tract 3.
• The risk of upper gastrointestinal bleeding with aspirin is increased with old age, male sex, ulcer history, and concomitant medication with NSAIDs, cyclooxygenase 2 selective inhibitors, corticosteroids, or other antithrombotic agents 3.
• To reduce the gastrointestinal risk, concomitant therapy with antisecretory agents, especially proton pump inhibitors (PPIs), can be used 3.
• Studies have shown that PPIs, such as omeprazole, are effective in preventing gastroduodenal mucosal breaks in high-risk users of low-dose aspirin 4.
• Histamine-2 receptor antagonists, such as famotidine, can also be used to prevent peptic ulcers and erosive oesophagitis in patients taking low-dose aspirin 5.
• However, PPIs have been shown to be superior to histamine-2 receptor antagonists in preventing gastroduodenal mucosal breaks in high-risk users of low-dose aspirin 4.
• The choice of medication to relieve stomach discomfort from aspirin should be based on individual patient needs and medical history, and should be made in consultation with a healthcare professional.

Comparison of Medications

• Omeprazole and famotidine have been compared in several studies, with omeprazole showing superior efficacy in preventing gastroduodenal mucosal breaks and erosive oesophagitis 4, 6.
• However, famotidine has been shown to be effective in preventing peptic ulcers and erosive oesophagitis in patients taking low-dose aspirin, and may be a suitable alternative for patients who cannot tolerate PPIs 5.
• The effects of PPIs and histamine-2 receptor antagonists on the antiplatelet function of clopidogrel have also been studied, with omeprazole showing a significant reduction in the antiplatelet effect of clopidogrel 7.
• Famotidine, on the other hand, has been shown to have no effect on the antiplatelet function of clopidogrel 7.