Aspirin Contraindications & Interactions
50 million American adults are on aspirin heart therapy (AHT)1
Your guidance can help patients choose an OTC analgesic appropriately.
For patients on aspirin heart therapy, adding any NSAID for pain relief increases the risk of GI bleeding2. Furthermore, taking ibuprofen can compromise aspirin’s cardioprotective benefits3.
Below is a list of medical conditions and potential drug interactions to consider before recommending aspirin for pain management. It is not a substitute for the full OTC Drug Facts label. Patients should always read and follow the product label for additional product information.
STOMACH ULCERS AND GI BLEEDING
Patients who are age 60 or older and patients with a history of GI problems who take any NSAID, including aspirin, are at higher risk for serious GI events such as stomach bleeding and ulcers.
Aspirin and other NSAIDs may be associated with modest increases in blood pressure. The adverse effect of NSAIDs on hypertension may have the most clinical impact in elderly patients, who have a high prevalence of arthritis, hypertension, and NSAID use2,4.
LIVER CIRRHOSIS OR LIVER DISEASE
Aspirin and other NSAIDs are metabolized in the liver and can therefore pose risks for patients with hepatic problems5.
For patients who have renal abnormalities, using aspirin or other NSAIDs may lead to chronic kidney disease.6 Adverse renal events from NSAIDs may be dependent on dose and therapy duration, and can include nephritic syndrome, reduced glomerular filtration, and chronic renal failure7.
In some adults who have asthma, aspirin and other NSAIDs that inhibit COX-1 can aggravate the condition8.
ANTIPLATELET MEDICATIONS OR ANTICOAGULANTS
Antiplatelet medicines—including low-dose aspirin—pose their own risks of GI complications and bleeding. Adding aspirin or any NSAID can compound these risks. Concomitant use of anticoagulants and NSAIDs also increases GI bleeding risks2,9.
Aspirin and other NSAIDs may be associated with modest increases in blood pressure. They may diminish the effects of certain antihypertensive agents, including beta blockers, ACE inhibitors and diuretics4.
ASPIRIN HEART THERAPY
For patients on an aspirin regimen, the use of ibuprofen can reduce aspirin’s cardioprotective benefits3. Also, taking any NSAID while on aspirin therapy can increase the risk of GI bleeding2.
More than 900 OTC and prescription medicines contain an NSAID. The use of aspirin when there is frequent chronic use of other NSAIDs can increase the chances of stomach bleeding.
Using aspirin or other NSAIDs with corticosteroids increases the risk of severe stomach bleeding, possibly because steroids can decrease production of protective gastric mucus, which in turn can delay healing of NSAID-induced erosions10,11.
DO NOT USE
If you are allergic to aspirin or any other pain reliever/fever reducer.
If a patient consumes three or more alcoholic drinks every day while taking aspirin or another NSAID, the chance of GI bleeding increases.
Aspirin is indicated for temporary relief of headache, pain and fever of colds, minor pain of arthritis, muscle pain, menstrual pain, and toothache.
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TEACH · REMIND · REASSURE
Patient counsel on OTC pain relievers
Patients may not realize that certain OTC pain relievers can have health consequences, based on their health conditions and other medicines they take. They also may not know that aspirin is an NSAID.
Check the active ingredients in all medicines they take. Look for “NSAID” on labels.
Take ONLY 1 medicine that contains an NSAID at a time.
If they’re not sure which pain reliever to choose or how to use it, consult you or another healthcare professional first.
When taken as directed, aspirin can provide safe, effective pain relief.
Choosing an OTC pain reliever carefully—and using it as directed—is important to their health.
Stay informed about key considerations in OTC analgesia
Get a checklist on patient health factors that may affect your recommendations
Help ensure patients choose and use OTC analgesics safely
Share free handouts with patients to help reinforce your recommendation
References: 1. Campbell CL, Smyth S, Montalescot G, Steinhubl SR. Aspirin dose for the prevention of cardiovascular disease. JAMA. 2007;297(18):2018-2024. 2. Bhatt DL, Scheiman J, Abraham NS, et al. ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use. Circulation. 2008; 118(8):1894-1909. 3. Catella-Lawson F, Reilly MP, Kapoor SC, et al. Cyclooxygenase inhibitors and the antiplatelet effects of aspirin. N Engl J Med. 2001;345(25):1809-1817. 4. Calhoun DA, Jones D, Textor S, et al. Resistant hypertension: diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension. 2008;51:1403-1419. 5. Chandok N, Watt KDS. Pain management in the cirrhotic patient: the clinical challenge. Mayo Clin Proc. 2010;85(5):451-458. 6. National Kidney Foundation. Pain medicines (analgesics). https://www.kidney.org/atoz/content/painmeds_analgesics. Accessed May 19, 2016. 7. Decloedt E, Maartens G. Drug-induced renal injury. CME. 2011;29(6):252-255. 8. Peterson GM. Selecting nonprescription analgesics. Am J Ther. 2005;12:67-79. 9. Risser A, Donovan D, Heintzman J, Page T. NSAID prescribing precautions. Am Fam Physician. 2009;80(12):1371-1378. 10. Guslandi M. Steroid ulcers: any news? World J Gastrointest Pharmacol Ther. 2013;4(3):39-40. 11. Hernández-Díaz S, García Rodríguez LA. Steroids and risk of upper gastrointestinal complications. Am J Epidemiol. 2001;153:1089-1093.