Important considerations for the concurrent use of ASA and NSAIDs
- 1. Increased risk of GI toxicity; risk is increased five-fold over that with either agent alone.
- 2. With COX-2 selective inhibitors, concurrent use of ASA appears to abrogate the gastroprotective effects of selective COX-2 blockade.
- 3. Pharmacodynamic studies of ASA coadministration with ibuprofen and naproxen have demonstrated evidence of interference with ASA’s sustained reduction of TXA 2 and subsequent platelet inhibition.
Studies of ASA plus ibuprofen suggest that administration of ASA 2 hours prior to ibuprofen (rather than concurrently or following the use of ibuprofen) resulted in adequate (and sustained) suppression of TXA 2 and platelet function. Therefore, the results from this study suggest that staggering the use of these medications, with use of ASA first, may be beneficial in terms of platelet suppression. All NSAIDs bind reversibly to the COX site; as such, intermittent use of any NSAID may interfere with ASA effects as well. In patients using short half-life NSAIDs in an intermittent (PRN) manner, it may be advisable to take ASA prior to NSAID