Taking Low-Dose Aspirin With NSAIDs

Taking aspirin with another nonsteroidal anti-inflammatory drug (NSAID) can raise your risk of side effects and drug interactions.

If you take aspirin to help prevent a heart attack or blood clot, you may wonder if you can also treat pain with another over-the-counter NSAID like Advil (ibuprofen) or Aleve (naproxen). However, you should not take both at the same time unless your provider tells you to.

This article will go over what you should know about taking aspirin with other NSAIDs, as well as what you can do to minimize your risk of problems if you have to take more than one NSAID.

The Risk of Drugs Interactions With NSAIDs

Aspirin, ibuprofen, and naproxen are all types of NSAIDs, which work to reduce pain, treat fevers, and, at higher doses, lower inflammation.

These medications also share some side effects and risks. Gastrointestinal symptoms are common in people who use NSAIDs. People who take the medications regularly are also at a higher risk for GI bleeding and peptic ulcers.

Even at a low dose, combining aspirin with another NSAID can increase the risk of ulcers. Some people are at a much higher risk for ulcers and should not use more than one NSAID.

The risk of ulcers when using NSAIDs is highest for people who are:

• Over 65 years old
• Taking corticosteroid medications
• On blood thinners such as Coumadin (warfarin) or Plavix (clopidogrel)
• Smokers
• Heavy alcohol users
• Have gastrointestinal bleeding or a history of ulcers

How to Minimize GI Risk With NSAIDs

There are some steps that you can take to prevent side effects and lower your risk if you are taking NSAIDs, including:

• Choosing an NSAID that is less likely to cause bleeding. Some less common anti-inflammatory drugs like Disalcid (salsalate), low-dose Celebrex (celecoxib), Voltaren (diclofenac), and Mobic (meloxicam) can be effective at treating pain and are far less likely to cause bleeding than other NSAIDs. Compared to ibuprofen or naproxen, they are also less likely to interfere with the heart-protective benefits of aspirin.
• Taking non-NSAIDs for other pain relief. If you need to take low-dose aspirin and are at risk for gastrointestinal symptoms, consider using a non-NSAID for other pain relief (e.g., arthritis). For example, you could try taking over-the-counter (OTC) Tylenol (acetaminophen), which relieves pain (however, it does not have an anti-inflammatory effect), or ask your provider if you could get a prescription for Ultram (tramadol), which provides strong pain relief.
• Use non-oral drug therapies. Your GI risk from NSAIDs will be lower if you do not take medications by mouth. Pain relievers that go on your skin (topical analgesic creams) provide a hot or cold sensation and are sometimes enough to help with your symptoms. There are also subdermal patches that have ibuprofen in them and may provide relief for over 12 hours.

Summary

NSAIDs like ibuprofen and naproxen treat pain. Aspirin can also help prevent a heart attack or blood clot. Taking more than one NSAID at the same time comes with risks, especially related to your stomach.

If your provider wants you to take aspirin daily, ask them if it would be safe for you to use a different NSAID for pain if you need it. There are also other medications you can take for pain that are not NSAIDs. 

A Word From Verywell

Always let your healthcare provider know which medications you are taking so they can advise you on any potential interactions.