Can Patients Using Aspirin for Cardioprotection Also Use NSAIDs or Selective COX-2 Inhibitors for Pain Relief?
Evidence indicates that ibuprofen, but not rofecoxib (a COX-2 inhibitor), acetaminophen, or diclofenac, interferes with aspirin’s ability to irreversibly acetylate the platelet COX-1 enzyme, and it would be expected, although it has not been proved, that this would reduce the protective effect of aspirin on risk for atherothrombotic events. Per an U.S. Food and Drug Administration (FDA) advisory: “Patients taking immediate release low-dose aspirin (not enteric coated) and ibuprofen 400 mg should take the ibuprofen at least 30 minutes after aspirin ingestion, or at least 8 hours before aspirin ingestion to avoid any potential interaction. . . . Recommendations about concomitant use of ibuprofen and enteric-coated low dose aspirin cannot be made based on available data. One study showed that the antiplatelet effect of enteric-coated low dose aspirin is attenuated when ibuprofen 400 mg is dosed 2, 7, and 12 hours after aspirin.” Of note, the combination of aspirin (necessary for protectio
