Taking Low-Dose Aspirin With NSAIDs

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It is not unusual to hear about people who take a daily, low-dose aspirin to lower their heart attack risk while treating their arthritis with a similar drug like Advil (ibuprofen) or Aleve (naproxen).

But is it a safe thing to do? And, if not, what alternatives might a person have to better treat both of these conditions?

Potential Drug Interactions

It is important to understand that aspirin, ibuprofen, and naproxen all belong to the same class of medications known as nonsteroidal anti-inflammatory drugs (NSAIDs). They all have similar mechanisms of action and work by reducing pain, treating fever, and, at higher doses, lowering inflammation.

One of the things these medications also share is side effects. Gastrointestinal symptoms are common in people who use NSAIDs, increasing the risk of bleeding and the development of potentially serious peptic ulcers.

Even at a low dose, combining aspirin with another NSAID may increase the risk of ulcers, most especially in people who are:

  • Over 65
  • Taking corticosteroid medications
  • On blood thinners such as Coumadin (warfarin) or Plavix (clopidogrel)
  • Smokers
  • Heavy drinkers
  • Experiencing gastrointestinal bleeding or have a history of ulcers

It is in the group of people that the combined use should be avoided.

5 Ways to Minimize Gastrointestinal Risk

There are several ways to minimize these side effects if taking low-dose aspirin with another NSAID:

  • Choose an NSAID 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 in treating pain and far less likely to cause bleeding. Moreover, compared to ibuprofen or naproxen, they are less likely to interfere with the cardioprotective benefits of aspirin.
  • Use drugs other than NSAIDs to treat arthritis. For those who really need to use a low-dose aspirin and are at risk of gastrointestinal symptoms, changing to non-NSAID-class drugs may be the most appropriate option. These include Tylenol (acetaminophen), which relieves pain but has no anti-inflammatory effect, and Ultram (tramadol), which provides strong pain relief but requires a prescription.
  • Use non-oral drug therapies. By avoiding oral medications, you are inherently at lower risk of developing stomach or ulcer problems. Topical analgesic creams that provide a hot or cold sensation are sometimes enough to provide localized pain relief. There are also subdermal patches containing ibuprofen that are reported to provide relief for over 12 hours.
  • Choose an NSAID less likely to cause bleeding. If you are taking daily, low-dose aspirin, you're probably already in care with a general practitioner or cardiologist. In such a case, it is important to let your doctor know of any and all drugs you may be taking. This ensures that the necessary tests are being performed to monitor your blood count, liver function, and kidney function. Tests are typically repeated every eight to 10 weeks when first starting and increases to every three to six months once a person's blood works are normal and stabilized.
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Article Sources
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  2. Colebatch AN, Marks JL, Edwards CJ. Safety of non-steroidal anti-inflammatory drugs, including aspirin and paracetamol (acetaminophen) in people receiving methotrexate for inflammatory arthritis (rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, other spondyloarthritis). Cochrane Database Syst Rev. 2011;(11):CD008872. doi:10.1002/14651858.CD008872.pub2

  3. Moore N, Pollack C, Butkerait P. Adverse drug reactions and drug-drug interactions with over-the-counter NSAIDs. Ther Clin Risk Manag. 2015;11:1061-75.  doi:10.2147/TCRM.S79135

  4. Heart-safer NSAID alternatives. Harvard Medical School. 2019.

  5. Tombs EL, Nikolaou V, Nurumbetov G, Haddleton DM. Transdermal Delivery of Ibuprofen Utilizing a Novel Solvent-Free Pressure-sensitive Adhesive (PSA): TEPI® Technology. J Pharm Innov. 2018;13(1):48-57.  doi:10.1007/s12247-017-9305-x

Additional Reading
  • Colebatch, A.; Marks, J.; and Edwards, C. "Safety of Non-steroidal Anti-inflammatory Drugs, Including Aspirin and Paracetamol (Acetaminophen) in People Receiving Methotrexate for Inflammatory Arthritis (Rheumatoid Arthritis, Ankylosing Spondylitis, Psoriatic Arthritis, Other Spondyloarthritis)." ​Cochrane Database of Systematic Reviews. 2011; 11: CD008872.