Will concomitant use of Aspirin (acetylsalicylic acid) and Celebrex (celecoxib) result in a negative outcome?

From the Guidelines

Taking aspirin with Celebrex (celecoxib) is generally not recommended due to increased risk of side effects, particularly gastrointestinal bleeding and cardiovascular problems, as evidenced by studies such as 1. When considering the combination of aspirin and Celebrex, it's essential to weigh the potential benefits against the risks. Both medications are anti-inflammatory drugs that work through similar mechanisms, and combining them can significantly increase the risk of adverse effects. The use of aspirin in combination with a coxib, such as Celebrex, may attenuate or eliminate the gastrointestinal advantage of a coxib over a non-selective NSAID, as suggested by 1.

Some key points to consider when evaluating the risks and benefits of combining aspirin and Celebrex include:

• The comparative gastrointestinal risks associated with non-selective NSAIDs plus aspirin versus coxibs plus aspirin have not been assessed in a randomized fashion, as noted in 1.
• The combination of aspirin and a non-selective NSAID increases the rate of clinical gastrointestinal events 2- to 5-fold, an increase similar to that with aspirin plus a coxib, as reported in 1.
• Concomitant non-selective NSAID use may attenuate the benefits of aspirin therapy, and recent studies of ibuprofen indicate that it may inhibit aspirin's cardiovascular benefits and even increase the risk of cardiovascular events, as discussed in 1.

If you're currently taking Celebrex for a condition like arthritis or pain management, you should avoid taking aspirin for pain relief and instead consider acetaminophen (Tylenol) as a safer alternative if additional pain relief is needed. However, if you're taking low-dose aspirin (81 mg) for heart protection as prescribed by your doctor, you may be able to continue this while on Celebrex, but only under close medical supervision, as suggested by 1 and 1. Always consult with your healthcare provider before combining these medications or making any changes to your medication regimen, as they can evaluate your specific health situation and risks.

From the FDA Drug Label

In the setting of concomitant use of low-dose aspirin for cardiac prophylaxis, inform patients of the increased risk for and the signs and symptoms of GI bleeding [see Warnings and Precautions (5.2)]. Use of NSAIDS and Low-Dose Aspirin Inform patients not to use low-dose aspirin concomitantly with celecoxib capsules until they talk to their healthcare provider [see Drug Interactions (7)]. NSAIDs and Salicylates Clinical Impact: Concomitant use of Celecoxib with other NSAIDs or salicylates (e.g., diflunisal, salsalate) increases the risk of GI toxicity, with little or no increase in efficacy [see Warnings and Precautions (5. 2)].

The use of aspirin with celebrex may increase the risk of GI bleeding and GI toxicity. Patients should be informed of the increased risk and signs and symptoms of GI bleeding, and should not use low-dose aspirin concomitantly with celecoxib capsules until they talk to their healthcare provider 2. The concomitant use of celecoxib with other NSAIDs or salicylates, including aspirin, is not recommended due to the increased risk of GI toxicity with little or no increase in efficacy 2.

• Key points:
  • Increased risk of GI bleeding
  • Increased risk of GI toxicity
  • Concomitant use not recommended
• Recommendation: Patients should avoid using aspirin with celebrex unless advised by their healthcare provider 2.

From the Research

Aspirin and Celebrex Interaction

• The concomitant use of low-dose aspirin with any NSAID, including Celebrex, increases the risk of gastrointestinal complications and diminishes the improved gastrointestinal safety profile of Celebrex 3.
• A study comparing the incidence of gastroduodenal ulcers in patients treated with low-dose aspirin and Celebrex or naproxen plus lansoprazole found that the rate of endoscopically confirmed gastroduodenal ulcers was not different between the two groups 4.
• The use of Celebrex or naproxen plus lansoprazole resulted in similar rates of gastroduodenal ulceration in patients with osteoarthritis taking low-dose aspirin 4.
• Celebrex remains an effective and useful alternative to nonselective NSAIDs in the treatment of acute or chronic musculoskeletal pain, offering improved gastrointestinal tolerability and a GI safety advantage in patients not taking aspirin for cardioprophylaxis 5.
• The safety of combining NSAIDs, including Celebrex, with low-dose aspirin is uncertain, and the potential GI, CV, and renal risks must be weighed against the potential benefits in each individual 5, 6.

Safety Considerations

• Adding aspirin to Celebrex attenuates the safety advantage of Celebrex, although Celebrex is still associated with fewer gastrointestinal events than ibuprofen or naproxen and fewer renal events than ibuprofen 6.
• The use of a fixed-dose aspirin/PPI combination could potentially provide chemopreventive benefit to patients with Barrett's esophagus, and at the same time, treat the underlying gastroesophageal reflux responsible for the condition 7.
• Prolonged use of PPIs may lead to serious adverse effects or reduce the cardioprotective effects of aspirin, and physicians need to carefully consider the benefits and risks associated with the condition of each patient to optimize clinical outcomes of combination therapy 7.