DOES IBUPROFEN EFFECT THE BLOOD THINNING EFFECTS OF ASA?

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The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

Questions. Lots and lots of questions. People call the pharmacy with all sorts of questions all the time. One came in the other day that gave me pause. “Is it true that ibuprofen will make low dose ASA not thin the blood as well as before?” I had no idea. It was time to do some reading. Here is what I found.

There was a study published in the New England Journal of Medicine in 2001 in which the researchers tried to see if ibuprofen, acetaminophen (the medication in Tylenol), diclofenac or rofecoxib (the medication in the prescription medication Vioxx) effected the blood thinning properties of 81 mg of ASA. It turned out that the ibuprofen effected the blood thinning properties of ASA if the ibuprofen was taken first. The diclofenac and rofecoxib did not effect the blood thinning properties of ASA. If the ASA was taken first by 2 hours, the ibuprofen didn’t effect the blood thinning properties.

Another study in the Lancet in 2003 looked at Scottish patient with heart disease. These patients were divided into 4 groups: ASA alone, ASA plus ibuprofen, ASA plus diclofenac, and ASA plus any other NSAID. More people died from any cause who were on ASA plus ibuprofen than ones who were on ASA alone. There was no difference in mortality between the ASA alone group and ASA plus diclofenac and ASA and any other NSAID groups.

Well, what does this all mean? First, the question needs more study. There are more studies that support the idea that ibuprofen might counter-act the heart protecting effects of ASA. These studies aren’t the final word. There might be something else going on. So what should we do?

If you are on low dose ASA to protect your heart, it might be wise to avoid ibuprofen altogether. We know that ASA plus another NSAID like ibuprofen can increase the chance of stomach problems like ulcers. Now it looks like ibuprofen may reduce ASA’s heart protective effects. What should you use if you are on low dose ASA and need a pain killer? Acetaminophen (Tylenol) is a good choice for most people. The problem is acetaminophen doesn’t help with inflammation. So if acetaminophen doesn’t help, ask your doctor if one of the prescription NSAID’s like rofecoxib or diclofenac is right for you. What if you absolutely feel you want to take ibuprofen? It is probably okay if ibuprofen is taken once in a while, if it is taken 2 hours after the ASA.

Hopefully this will help make sense of the new Tylenol ads on TV bashing ibuprofen.

As always if you have any questions or concerns about these or other products, ask your pharmacist.