Can someone taking Aspirin (acetylsalicylic acid) also take Celebrex (celecoxib)?

From the Guidelines

It is not recommended to take Celebrex (celecoxib) and aspirin together without medical supervision due to the increased risk of gastrointestinal bleeding and ulcers, as well as potential interference with aspirin's cardioprotective effects. Both medications are non-steroidal anti-inflammatory drugs (NSAIDs) that work in similar ways, and combining them can lead to adverse effects. According to the study published in the American Family Physician in 2009 1, the risk of gastrointestinal bleeding is dependent on age and patient history, with a one-year risk of one in 2,100 adults younger than 45 and one in 110 adults older than 75.

The American Heart Association's scientific statement from 2007 1 also highlights the importance of considering the benefits and risks of combining Celebrex and aspirin, particularly in patients with a high risk of cardiovascular events. The statement recommends that physicians consider alternative therapy or use the smallest effective dose of Celebrex, and that patients at high risk of gastrointestinal bleeding or with a history of intolerance to nonselective NSAIDs may be appropriate candidates for COX-2 selective agents.

Key considerations when taking Celebrex and aspirin together include:

• The timing of doses, with aspirin taken at least 30 minutes before Celebrex or 8 hours after
• Careful monitoring of gastrointestinal bleeding and ulcers
• Assessment of individual patient risk for cardiovascular events and other risks commonly associated with NSAIDs
• Consideration of alternative therapy or use of the smallest effective dose of Celebrex

Ultimately, the decision to combine Celebrex and aspirin should be made under the guidance of a healthcare provider, who can assess the patient's specific health situation and determine the best course of treatment.

From the FDA Drug Label

Aspirin Clinical Impact: Controlled clinical studies showed that the concomitant use of NSAIDs and analgesic doses of aspirin does not produce any greater therapeutic effect than the use of NSAIDs alone In a clinical study, the concomitant use of an NSAID and aspirin was associated with a significantly increased incidence of GI adverse reactions as compared to use of the NSAID alone Intervention: Concomitant use of celecoxib capsules and analgesic doses of aspirin is not generally recommended because of the increased risk of bleeding

Concomitant use of celecoxib and aspirin is not generally recommended due to the increased risk of bleeding. The use of celecoxib with aspirin may increase the risk of gastrointestinal adverse reactions.

• Increased risk of bleeding: Concomitant use of celecoxib and aspirin may increase the risk of bleeding due to the synergistic effect on hemostasis.
• No greater therapeutic effect: Controlled clinical studies have shown that the concomitant use of NSAIDs and analgesic doses of aspirin does not produce any greater therapeutic effect than the use of NSAIDs alone. 2

From the Research

Gastrointestinal Safety of Celecoxib and Aspirin

• The use of celecoxib with a proton-pump inhibitor is considered safer than a non-selective NSAID with a proton-pump inhibitor in patients at high risk of gastrointestinal and cardiovascular events who are also taking aspirin 3, 4.
• A study found that the cumulative incidence of recurrent bleeding in 18 months was 5.6% in the celecoxib group and 12.3% in the naproxen group, indicating that celecoxib is a preferred treatment to reduce the risk of recurrent upper gastrointestinal bleeding in patients taking aspirin 3.

Interaction between Aspirin and NSAIDs

• Concomitant use of low-dose aspirin with any NSAID increases the risk of gastrointestinal complications and diminishes the improved gastrointestinal safety profile of celecoxib 5.
• The use of ibuprofen plus PPI regimens may negate aspirin's antiplatelet benefits, while celecoxib may be a safer option for patients taking aspirin 5.

Cardiovascular and Gastrointestinal Risks

• The choice of NSAID should be tailored to the gastrointestinal and cardiovascular risks in the patient, taking into account factors such as NSAID dosing and concurrent aspirin use 6, 7.
• Celecoxib, a COX-2 selective agent, seems safer for both the upper and lower gastrointestinal tract, but its use should be individualized based on the stratification of the cardiovascular and gastrointestinal risk of patients 7.