Take ibuprofen and baby aspirin at different times
Q: I take ibuprofen every morning for my arthritis. My doctor wants me to take low-dose aspirin every day to reduce my heart attack risk. Ibuprofen and aspirin are both NSAIDs, right? So will the ibuprofen help my arthritis and my heart? Or should I take both?
A: When joints ache, many people turn to nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief.
Aspirin is a type of NSAID. So are ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn). NSAIDs are widely used because they perform double duty. They relieve pain and also reduce inflammation.
But aspirin and other NSAIDs are not equal when it comes to heart disease risk. Daily, low-dose (“baby”) aspirin reduces the risk of further heart trouble in people with known heart disease, and in people at high risk for developing heart disease.
In contrast, other NSAID drugs somewhat increase heart disease risk. Doctors first recognized this risk when a new type of NSAID drug, called COX-2 drugs, came on the market. One of them was called Vioxx. Vioxx and one other COX-2 drug were taken off the market because people who used them had a higher risk of high blood pressure and heart trouble.
Subsequently, research revealed that several of the older types of NSAIDs (perhaps not including naproxen) slightly increased heart risks. In my opinion, this is so slight that most people don't need to worry.
Why do some NSAIDs pose a risk to the cardiovascular system?
First, they reduce the ability of aspirin to inhibit blood clots. A blood clot can block a narrowed artery in the heart, triggering a heart attack. Second, they cause the kidneys to retain more salt and water. That triggers blood pressure to rise, boosting the risk of a stroke.
High blood pressure also makes people more prone to atrial fibrillation — a rapid, quivering motion of the heart's upper chambers that also increases stroke risk. Finally, they probably increase the tendency of the arteries that feed the heart to narrow.
Aspirin helps prevent heart attack and stroke by making the blood less likely to clot.
Aspirin attaches to blood cells called platelets to make them less sticky. This decreases the risk of blood clots forming in heart arteries.
Aspirin also decreases the tendency of the arteries that feed the heart to narrow.
You take both ibuprofen and aspirin. You need to know that taking ibuprofen can reduce the heart-protective effect of aspirin. The reason is that ibuprofen latches on to platelets in the blood at the same spots where aspirin attaches to platelets, thereby decreasing the anti-clotting effects of aspirin.
If you need to take both, take the baby aspirin first, in the morning with breakfast. Then wait at least an hour (preferably two) before taking ibuprofen.
You can also try to use non-drug therapies to treat your arthritis pain. Heating pads, ice or physical therapy, if appropriate, may help. Even if these approaches don't eliminate your pain, they may let you take a lower dose of ibuprofen.
• Dr. Anthony Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.