A number of my older patients who take a daily aspirin have been told in the past that they could not take a nonsteroidal anti-inflammatory drug (NSAID) as well. Is there any evidence that NSAIDs will reduce the effectiveness of aspirin? Similarly, is there any evidence that warfarin (Coumadin) therapy will be affected by NSAID use?
—Roger Hansen, DO, PhD, Panora, Iowa
NSAIDs are very useful drugs, although their potential for causing adverse cardiovascular effects has received tremendous publicity (especially the COX-2 preparations) and this has limited their popular appeal. Nevertheless, those NSAIDs that are still available OTC have their faithful adherents, so the problem of concomitant aspirin usage is a real one. What do the data tell us? Popular drugs like naproxen (Aleve) and ibuprofen (Advil, Motrin) do blunt the antiplatelet effects of aspirin. Steinhubl recently suggested several options to get around the problem (J Am Coll Cardiol. 2005;45:1302-1303). These include common sense (use the shortest treatment course possible for the NSAIDs) and specific suggestions (taking enteric-coated aspirin two hours before the NSAID dose). There is no similar interaction of the NSAIDs with warfarin, so use of that combination is not a problem.
—Peter F. Cohn, MD (107-14)
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