October 18, 2006

Concomitant Use of Ibuprofen and Aspirin

THE ISSUE
On Sept. 8, 2006, the FDA released new information
to health care providers and consumers stating that
the concomitant use of ibuprofen and low-dose aspirin
may hinder the anti-platelet effect of aspirin.
THE WARNING
Although there have been no studies demonstrating an
increased risk for thromboembolic events in patients
who are taking ibuprofen and aspirin concomitantly,
recent literature has shown that ibuprofen will
significantly attenuate the anti-platelet activity of
aspirin. These studies caused the FDA to issue a
statement about the potential loss of aspirin’s cardio
protective and stroke prevention effects when
administered with ibuprofen.
WHAT YOU NEED TO KNOW
Aspirin and ibuprofen, like all non-steroidal anti-
inflammatory drugs (NSAIDs), are non-selective
cyclooxygenase (COX) inhibitors. While ibuprofen
reversibly inhibits the COX enzyme, aspirin inhibits it
irreversibly by acetylating a serine residue on the COX
enzyme. The long duration of aspirin’s effects make it
useful in preventing thromboembolic events. The
inhibition of COX-1 in platelets decreases the
production of thromboxane, a substance that promotes
platelet aggregation. When ibuprofen is given prior to
administration of aspirin it temporarily binds to the
COX catalytic site and prevents aspirin from accessing
the enzyme. The aspirin will then be excreted or
metabolized before it can exert its anti-platelet effect.
COX-2 inhibitors and acetaminophen do not appear to
interfere with the acetylating activity of aspirin.
WHAT YOUR PATIENTS NEED TO KNOW
Patients who use immediate-release low-dose aspirin
for its cardio protective and stroke prevention effects
should space doses of ibuprofen at least 30 minutes
after or eight hours before taking aspirin. Patients
should be told that ibuprofen may preclude the aspirin
from preventing clots. However, there is likely minimal
risk in using occasional ibuprofen due to the long-
lasting effect of aspirin. Additionally, it is not known
whether ibuprofen interferes with the anti-platelet
effect of enteric-coated aspirin. Finally, patients
should be informed that other prescription and OTC
NSAIDs have not been thoroughly studied and should
also be viewed as having an effect similar to that of
ibuprofen. If your patients are concerned about the
drug interaction between ibuprofen and aspirin you
may recommend acetaminophen for pain relief.

RESOURCES
Patient Information Sheet: http://www.fda.gov/cder/drug/infopage/ibuprofen/default.htm

Health Care Provider Information Sheet: http://www.fda.gov/cder/drug/InfoSheets/HCP/ibuprofen_aspirinHCP.htm

FDA Science Background Paper: http://www.fda.gov/cder/drug/infopage/ibuprofen/science_paper.htm

Renda G, Tacconelli S, Capone ML, et al. Celecoxib, ibuprofen, and the antiplatelet effect of aspirin in patients with
osteoarthritis and ischemic heart disease. Clin Pharmacol Ther. 2006;80:264-274.

Catella-Lawson F, Reilly MP, Kapoor SC, et al. Cyclooxygenase inhibitors and the antiplatelet effects of aspirin. N
Engl J Med. 2001;345:1809-1817.

DISCLAIMER
This publication is intended to provide key practical information regarding this drug product in a brief format. It does not contain
sufficient information upon which to base formulary or other medication use policy decisions.

The information provided was developed by the Center for Drug Policy at the
University of Wisconsin Hospitals and Clinics and published by the Pharmacy Society of Wisconsin.