Pete asked
I take 75mg of aspirin daily for heart (have very early issues with arteries diagnosed by heart specialist) and am taking 10mg atorvastatin. I have periodic bad back pains and cannot take other NSAIDS like ibuprofen. What can I take for my back pain without compromising aspirin?
Answer
Aspirin is recommended for a variety of patients for the primary and secondary prevention of myocardial infarction (i.e. heart attack) by numerous organizations
Both the USPSTF (United States Preventive Services Task Force) and the AHA (American Heart Association) recommend the use of low dose aspirin in certain populations that have risk factors for cardiovascular disease. Recommendations vary by age and other risk factors so it is important that your doctor be the one to recommend use of low dose aspirin. Low dose aspirin most commonly refers to 81 mg (i.e. baby aspirin) but can range from 75 mg to 162 mg.
In those taking low dose aspirin for preventative care, it can sometimes be difficult to find a safe and effective pain reliever that won't interact with aspirin or increase the risk of side effects. Below, we talk about over the counter pain relievers that are considered to be safe with aspirin and ones to avoid.
Pain Medications To Avoid With Taking Aspirin
One medication class, NSAIDs (Non-Steroidal Anti-Inflammatory Drugs), are often recommended to be avoided altogether in those taking aspirin, although there is conflicting data regarding this. Common over the counter NSAIDs include:
- Advil (ibuprofen)
- Motrin (ibuprofen)
- Aleve (naproxen)
Many NSAIDs can interfere with the anti-platelet (i.e. blood thinning) effect of aspirin. Not only can NSAIDs increase the risk of bleeding events (such as stomach bleeds and increased bruising), taking them before a dose of aspirin can potentially can block aspirin’s access to its site of action, making it ineffective.
However, aspirin takes about one hour after taking by mouth to begin working (i.e. inhibit blood platelets). Some studies suggest that taking a NSAID (such as ibuprofen) after aspirin has exerted its anti-platelet effect will minimize the potential interaction.
Several studies have investigated the interaction between NSAIDs and aspirin, as well as how to avoid it:
- One study showed that taking ibuprofen two hours after aspirin avoids the interaction between the two medications.
- Another study concluded that ibuprofen, taken at least 1 hour after aspirin dosing, does not affect aspirins ability to inhibit blood platelets.
- Lastly, one study states that all NSAIDs should be avoided in those taking enteric coated (i.e. EC) aspirin. The study showed that the anti-platelet effect of enteric-coated low-dose aspirin is lessened when ibuprofen was given hours after the aspirin dose, most likely because the absorption of enteric-coated aspirin is delayed when compared to immediate-release aspirin.
As information is conflicting and more studies are needed on the matter, it would be prudent to avoid using ibuprofen and naproxen in those taking low dose aspirin for cardio-protection if alternative pain medications are available.
At the very least, if ibuprofen or naproxen are the only options:
- They should be taken at least one hour after aspirin to give aspirin time to bind to platelets.
- Ibuprofen (Advil, Motrin) should be taken no sooner than eight hours before aspirin, allowing enough time for the medication to be metabolized and eliminated from your system.
- Naproxen (Aleve) should be taken no sooner than twelve hours before aspirin, allowing enough time for the medication to be metabolized and eliminated from your system.
- Use only immediate release aspirin products. Enteric coated products absorb slower and are more likely to interact with NSAIDs, even if dosed far apart.
As always, before making any changes to your medication regimen, be sure to speak with your doctor regarding your particular medical situation.
Pain Medications Considered Safe To Take With Aspirin
As mentioned above, if you are taking aspirin, over the counter NSAIDs may pose a problem.
Typically, Tylenol (acetaminophen) is the preferred analgesic as it does not interact with aspirin and does not have any anti-platelet (i.e. blood thinning) effects. Aside from Tylenol, the next best options are topical products such as:
- Bengay/IcyHot (menthol, camphor)
- Capsacin
- Aspercreme
- Lidocaine
If none of the above options are providing adequate pain relief, and NSAIDs aren't an option (as discussed above), stronger prescription medication may be needed such as tramadol or low dose, short term opioids.
