Can I take aspirin (acetylsalicylic acid) while on Renvoq?

Aspirin Use with Rinvoq (Upadacitinib)

Taking aspirin while on Rinvoq (upadacitinib) should generally be avoided unless there is a compelling cardiovascular indication, due to increased bleeding risk and potential drug interactions.

Risk Assessment for Combined Use

Bleeding Risk Considerations

• Rinvoq (upadacitinib) itself carries risks of serious adverse events including cardiovascular events, cancer, blood clots, and death as noted in FDA safety communications 1
• NSAIDs including aspirin increase the risk of gastrointestinal bleeding by approximately 1.5-3 fold when used alone 2
• When aspirin is combined with other medications that affect clotting, the bleeding risk increases significantly 2

Cardiovascular Considerations

• If you have established atherosclerotic cardiovascular disease (ASCVD), aspirin for secondary prevention may be warranted despite the increased bleeding risk 2
• For primary prevention (no history of heart attack or stroke), aspirin is generally not recommended as the bleeding risks outweigh cardiovascular benefits 2
• Patients under 50 years with diabetes and no other major ASCVD risk factors should not take aspirin for primary prevention 2

Decision Algorithm for Aspirin Use with Rinvoq

1. For patients with established ASCVD (secondary prevention):

   • Aspirin may be continued at the lowest effective dose (typically 81mg daily) 2
   • Consider adding a proton pump inhibitor (PPI) to reduce gastrointestinal bleeding risk 2
   • Monitor closely for signs of bleeding

2. For patients without established ASCVD (primary prevention):

   • Avoid aspirin while on Rinvoq due to additive bleeding risk 2
   • If pain relief is needed, consider acetaminophen (paracetamol) as it has no antiplatelet effects 3

3. For patients requiring dual antiplatelet therapy (e.g., recent stent):

   • This combination carries significantly higher bleeding risk
   • Limit duration of triple therapy (Rinvoq + dual antiplatelet) to absolute minimum necessary 3
   • Consider alternative JAK inhibitors if long-term antiplatelet therapy is required

Practical Management Recommendations

• If aspirin must be used with Rinvoq for cardiovascular protection:

  • Use the lowest effective dose (81mg daily) 2
  • Consider adding a PPI for gastroprotection 2
  • Monitor for signs of bleeding (bruising, blood in stool, prolonged bleeding) 3

• For pain management while on Rinvoq:

  • Use acetaminophen (paracetamol) as first-line 3
  • If NSAIDs are needed, consider those with less antiplatelet effect (e.g., diclofenac) 3
  • Avoid ibuprofen if also taking aspirin, as it can interfere with aspirin's cardioprotective effects 4

Special Precautions

• Patients with history of peptic ulcer disease, advanced age, renal impairment, or concomitant anticoagulant use have even higher bleeding risk with this combination 3
• If you experience signs of bleeding (easy bruising, blood in stool, prolonged bleeding from cuts), seek immediate medical attention
• Regular monitoring of blood counts may be warranted when combining these medications

The decision to use aspirin with Rinvoq should be based on a careful assessment of your individual cardiovascular risk versus bleeding risk, with preference given to avoiding the combination unless there is a compelling indication for aspirin therapy.