Can a 71-year-old male with normal renal function take ibuprofen for 2 days while on 81mg aspirin (acetylsalicylic acid)?

From the Guidelines

It is not recommended for a 71-year-old male with normal renal function to take ibuprofen for 2 days while on 81mg aspirin without consulting a doctor first, due to the increased risk of gastrointestinal bleeding and potential interference with aspirin's cardioprotective effects. For a patient taking daily low-dose aspirin, adding ibuprofen, even for a short period, can elevate the risk of adverse gastrointestinal effects, such as dyspepsia, abdominal pain, and GI bleeding, as noted in studies on NSAID prescribing precautions 1. If pain relief is necessary, acetaminophen (Tylenol) is generally a safer alternative to use alongside low-dose aspirin, with a typical adult dose of 325-650mg every 4-6 hours as needed, not exceeding 3000mg per day for older adults. Key considerations include:

• The potential for ibuprofen to compete with aspirin's binding sites, potentially reducing aspirin's effectiveness in preventing blood clots.
• The increased risk of gastrointestinal complications when combining NSAIDs, as seen in the one-year risk of GI bleeding being one in 2,100 adults younger than 45 and one in 110 adults older than 75 1.
• The importance of consulting a doctor before combining these medications, especially considering the patient's age and potential for other underlying health conditions. In cases where ibuprofen is deemed necessary by a healthcare provider, it should be taken at least 30 minutes after or 8 hours before the aspirin dose to minimize potential interference, and under close medical supervision.

From the FDA Drug Label

Pharmacodynamic studies have demonstrated interference with the antiplatelet activity of aspirin when ibuprofen 400 mg, given three times daily, is administered with enteric-coated low-dose aspirin. The interaction exists even following a once-daily regimen of ibuprofen 400 mg, particularly when ibuprofen is dosed prior to aspirin However, there was no interaction with the antiplatelet activity of aspirin when ibuprofen 400 mg, given once daily, was administered 2 hours after (but not concomitantly, 15 min, or 30 min after) the immediate-release aspirin dose [99. 2%].

Key Considerations:

• The patient is taking 81mg aspirin, which is a low-dose aspirin.
• The patient wants to take ibuprofen for 2 days.
• There is an interaction between ibuprofen and aspirin that can affect the antiplatelet activity of aspirin.

Answer: A 71-year-old male with normal renal function can take ibuprofen for 2 days while on 81mg aspirin, but it is recommended to take the aspirin at least 2 hours before taking the ibuprofen to minimize the interaction with the antiplatelet activity of aspirin 2. However, considering the potential increased risk of cardiovascular events due to the interference of ibuprofen with the antiplatelet effect of aspirin, it is recommended to consult a healthcare provider before taking ibuprofen with aspirin 2.

From the Research

Risks Associated with Concomitant Use of Ibuprofen and Aspirin

• The concomitant use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and low-dose aspirin increases the risk of upper gastrointestinal bleeding (UGIB) 3.
• A study found that monotherapy with NSAIDs increased the risk of UGIB to a greater extent than monotherapy with low-dose aspirin, with an incidence rate ratio (IRR) of 4.3 for NSAIDs and 3.1 for low-dose aspirin 3.
• Another study reported that the relative risk of major gastrointestinal bleeding with low-dose aspirin was 2.07, with an absolute rate increase of 0.12% per year 4.

Interaction between Ibuprofen and Aspirin

• A pharmacokinetic/pharmacodynamic model predicted that the antiplatelet effect of low-dose aspirin can be markedly reduced with combined use of ibuprofen, depending on the timing of co-administration 5.
• The study found that administering ibuprofen 1 hour or less after aspirin reduced the antiplatelet effect of aspirin, while administering ibuprofen more than 2 hours after aspirin did not have a significant effect 5.

Bleeding Risks with Long-Term Low-Dose Aspirin

• A systematic review of observational studies found that long-term low-dose aspirin use was associated with an increased risk of gastrointestinal bleeding, with a pooled estimate of the relative risk of 1.4 6.
• Another systematic review found that very-low-dose aspirin use increased the risk of major gastrointestinal bleeding by 58% and hemorrhagic stroke risk by 27% 7.

Considerations for a 71-Year-Old Male with Normal Renal Function

• The risks and benefits of concomitant use of ibuprofen and aspirin should be carefully weighed, taking into account the individual's baseline bleeding risk and expected benefits of aspirin therapy.
• The patient's age, renal function, and other comorbidities should be considered when assessing the risk of bleeding with concomitant use of ibuprofen and aspirin 3, 4, 6, 7.