What is the comparative efficacy of aspirin (acetylsalicylic acid) versus ibuprofen for analgesia?

From the Guidelines

Aspirin and ibuprofen have comparable efficacy for analgesia in the treatment of migraine headaches.

Key Points

• Both aspirin and ibuprofen are considered first-line treatments for acute migraine attacks, with the strongest evidence supporting their use as non-steroidal anti-inflammatory drugs (NSAIDs) 1.
• The efficacy of aspirin and ibuprofen is supported by multiple studies, with aspirin having a maximal initial dose of 1 g and maximal daily dosage of 4 g, and ibuprofen having a maximal initial dose of 800 mg and maximal daily dosage of 2.4 g 1.
• Both medications have potential adverse effects, including gastrointestinal upset, with aspirin also causing rectal irritation with suppository use, and ibuprofen causing dizziness and rash 1.
• The choice between aspirin and ibuprofen may depend on individual patient factors, such as tolerance and potential contraindications, with aspirin being contraindicated in patients with G6PD-deficiency or bleeding disorders, and ibuprofen being contraindicated in patients with aspirin/NSAID-induced asthma 1.

Treatment Considerations

• For mild to moderate migraine attacks, NSAIDs such as aspirin and ibuprofen are recommended as first-line treatment 1.
• For moderate to severe migraine attacks, or those that respond poorly to NSAIDs, other treatment options such as triptans, ergotamines, or combination therapy may be considered 1.
• Adjunctive therapy, such as metoclopramide or prochlorperazine, may be used to treat associated symptoms of migraine and provide synergistic analgesia 1.

From the FDA Drug Label

In clinical studies in patients with rheumatoid arthritis and osteoarthritis, ibuprofen tablets have been shown to be comparable to aspirin in controlling pain and inflammation and to be associated with a statistically significant reduction in the milder gastrointestinal side effects [see ADVERSE REACTIONS]

The comparative efficacy of aspirin versus ibuprofen for analgesia is that they are comparable in controlling pain and inflammation in patients with rheumatoid arthritis and osteoarthritis 2, 2.

• Key points:
  • Ibuprofen and aspirin have similar analgesic and anti-inflammatory effects
  • Ibuprofen may have a reduced risk of gastrointestinal side effects compared to aspirin
  • The mechanism of action is not completely understood, but may be related to prostaglandin synthetase inhibition

From the Research

Comparative Efficacy of Aspirin and Ibuprofen for Analgesia

• The comparative efficacy of aspirin (acetylsalicylic acid) versus ibuprofen for analgesia has been studied in several clinical trials 3, 4, 5, 6, 7.
• These studies have consistently shown that ibuprofen is as effective as aspirin for the treatment of mild to moderate pain, but with a lower risk of gastrointestinal toxicity 3, 4, 5, 7.
• A study published in the International Journal of Clinical Practice found that low-dose ibuprofen was as effective as aspirin and paracetamol for the treatment of common pain indications, but with a lower risk of gastrointestinal toxicity 3.
• Another study published in The Journal of International Medical Research found that ibuprofen had a lower incidence of gastrointestinal adverse events compared to aspirin, but a similar incidence compared to paracetamol 4.
• A study published in Clinical Rheumatology found that ibuprofen was statistically equivalent to paracetamol and better tolerated than aspirin for the treatment of musculoskeletal conditions 5.
• The PAIN study, a large randomized double-blinded trial, found that the main risk factors for adverse events in analgesic drug users were indication, concomitant use of medication, increasing number of other concomitant medications, treatment with aspirin, history of previous GI disorder, and female gender 6.
• A study published in the International Journal of Clinical Practice found that ibuprofen was significantly better tolerated than aspirin and had comparable tolerability with paracetamol for the treatment of cold and flu symptoms and sore throat pain 7.

Gastrointestinal Tolerability

• The gastrointestinal tolerability of ibuprofen, aspirin, and paracetamol has been compared in several studies 3, 4, 5, 7.
• These studies have consistently shown that ibuprofen has a lower risk of gastrointestinal toxicity compared to aspirin, but a similar risk compared to paracetamol 3, 4, 5, 7.
• A study published in The Journal of International Medical Research found that ibuprofen had a lower incidence of gastrointestinal adverse events compared to aspirin, but a similar incidence compared to paracetamol 4.
• The PAIN study found that the risk of gastrointestinal adverse events was lower with ibuprofen compared to paracetamol 6.

Adverse Events

• The incidence of adverse events has been compared in several studies 3, 4, 5, 6, 7.
• These studies have consistently shown that ibuprofen has a lower incidence of adverse events compared to aspirin, but a similar incidence compared to paracetamol 3, 4, 5, 7.
• The PAIN study found that the main risk factors for adverse events in analgesic drug users were indication, concomitant use of medication, increasing number of other concomitant medications, treatment with aspirin, history of previous GI disorder, and female gender 6.