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I’m taking an herbal medicine. Can I take an NSAID? Gastrointestinal Risk with NSAIDs Can I take an NSAID if I’m already taking low-dose aspirin to reduce my risk of heart attack or stroke? Does taking low-dose aspirin daily along with another NSAID increase my risk of gastrointestinal problems? How alarmed should I be about developing gastrointestinal problems if I take an NSAID? What are the symptoms of severe gastrointestinal side effects from NSAIDs and what should I do if I have any of them?

Digestive Health Digestive Health Basics

Taking Low Dose Aspirin and NSAIDs? Know Your Risk

Summary & Participants

Combining low dose aspirin with other NSAIDs can increase the risk of GI side effects. Listen as specialists describe the risks, and how to minimize them.

Medically Reviewed On: August 20, 2008

Webcast Transcript

ANNOUNCER: Millions of Americans take low dose aspirin to reduce their risk of heart attack and stroke. Aspirin is a drug called an NSAID - for non-steroidal, anti-inflammatory drug. NSAIDS may cause side effects because they reduce the body's protection from stomach acid.

BYRON CRYER, MD: NSAIDs have a range of gastrointestinal side effects, ranging from mild levels of symptoms such as stomach discomfort, nausea, to more severe abdominal pain, to more concerning side effects such as ulcers, gastrointestinal bleeding or perforation -- perforation being a hole in the stomach that could be caused by an NSAID.

ANNOUNCER: Unless a person has a history of gastrointestinal problems, the risk posed by low dose aspirin is small.

STANLEY ROCKSON, MD: It's quite low so that we don't certainly limit ourselves in any way from prescribing it if somebody does not have an overt history of having had problems in the past.

ANNOUNCER: But what about when a person needs another NSAID, such as ibuprofen or naproxen, for pain relief or to fight inflammation in addition to their low dose aspirin?

STUART SPECHLER, MD: One of the risk factors for developing a complication of NSAIDs is to take more than one NSAID at the same time. Well, aspirin is an NSAID, so if you're taking another NSAID at the same time, you are at increased risk for developing an ulcer complication.

BYRON CRYER, MD: When an individual combines low-dose aspirin along with an NSAID, the risk of having a gastrointestinal complication markedly increases. In fact, it increases about nine fold.

ANNOUNCER: The actual risk varies from person to person.

LAUREN GERSON, MD: The patients who are at risk for GI problems from NSAIDs include patients who have had previous peptic ulcer disease, complicated ulcers that have bleeding requiring hospitalization, patients of older age, patients who are taking steroids, blood thinners, and patients who are taking higher dosage of these drugs.

ANNOUNCER: There are steps people can take to lower GI risk.

BYRON CRYER, MD: There are a couple of strategies that can be pursued for the person who needs to take a chronic NSAID who also needs to take low-dose aspirin. One of the strategies would be to change the NSAID, to change the NSAID to a different class of NSAIDs, such as a COX-2 inhibitor.

ANNOUNCER: COX-2 selective NSAIDs do not interfere with low dose aspirin's cardio-protective effects. But there is still a GI risk.

BYRON CRYER, MD: Another strategy for reducing the gastrointestinal risk of people who are required to take NSAIDs along with aspirin would be to take this class of medicines, this acid blocker class of medicine, the proton pump inhibitors, along with the NSAID plus the low-dose aspirin to reduce the likelihood of a gastrointestinal complication.

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