Aspirin with NSAIDs

The additive risk of gastrointestinal damage from combining aspirin and NSAIDs is established. Because of this, and the lack of clear benefit from the combination, the use of anti-inflammatory/analgesic doses of aspirin with NSAIDs should be avoided. For information on low-dose aspirin and NSAIDs see NSAIDs + Aspirin Antiplatelet dose , p.l44. Consider also NSAIDs + NSAIDs , p. 151. 

Studies showing a decrease in the cardioprotection of aspirin with NSAIDs ... 

Case-control First non-fatal Ml Aspirin alone (694) Aspirin with NSAIDs (170) NSAIDs alone (128) Both aspirin alone, and NSAIDs alone were associated with a reduced risk of Ml, but combined use was not. 3... 

Retrospective cohort Discharge after Ml Death in first year Aspirin alone (36211) NSAID alone (736) Aspirin with NSAID (2096) Neither (9541) Risk of death reduced to a similar extent by aspirin, NSAIDs, and the combination. 4... 

Administration of zafirlukast and aspirin increases plasma levels of zafirlukast, When zafirlukast is administered with warfarin, there is an increased effect of the anti coagulant. Administration of zafirlukast and theophylline or erythromycin may result in a decreased level of zafirlukast. Administration of montelukast with other drugs has not revealed any adverse responses. Administration of montelukast with aspirin and NSAIDs is avoided in patients with known aspirin sensitivity. Administration of zileuton with propranolol increases the activity or the propranolol with theophylline increases serum theophylline levels and with warfarin may increase prothrombin time (PT). A prothrombin blood test should be done regularly in the event dosages of warfarin need to be decreased. 

Cross-reactions with aspirin and NSAIDs are of practical importance. Typically, AIA patients are sensitive to all NSAIDs that preferentially inhibit COX-1 (table 2). Acetaminophen (paracetamol), a weak inhibitor of COX-1, is regarded as a relatively safe therapeutic alternative for almost all patients with AIA. High doses of the drug (>1,000 mg) have been reported to provoke mild, easily reversed bronchos-pasm in some AIA patients [13]. Some rare, well-documented cases of coexistence of aspirin and paracetamol sensitivity have been described. However, according to a recent meta-analysis, less that 2% of asthmatics are sensitive to both aspirin and paracetamol [14]. 

Some patients with chronic idiopathic urticaria develop wheals and even angioedema after aspirin or NSAIDs. In others, aspirin causes an obvious increase in the underlying urticaria. The reaction may occur in just 15 min or up to 24 h following aspirin ingestion, but on average it develops within 1-4 h. Most cases resolve within a few hours, but in severe reactions bouts of multiform skin eruptions, covering most of the body, may continue for 10 days after aspirin intake [8,16,17]. 

Aspirin and NSAIDs can induce allergic and pseudoallergic reactions. Because these drugs are used so widely, with much over-the-counter use, the health care professional must have a basic understanding of the types of reactions that can occur and how to prevent them. Three types of reactions occur bron-chospasm with rhinoconjunctivitis, urticaria/angioedema, and anaphylaxis. Remember that patients with gastric discomfort... 

IgE -mediated urticarial/angioedema reactions and anaphylaxis are associated with aspirin and NSAIDs. Urticaria is the most common form of IgE-mediated reaction. This class is second only to fi-lactams in causing anaphylaxis. The potential for cross-reactivity between agents in IgE-mediated reactions appears small, but caution is advised. Because aspirin therapy is highly beneficial in primary and secondary prevention in... 

IM 15-60 mg q 4-6 h Weak analgesic use with NSAIDs, aspirin, or acetaminophen (continued)... 

Use in moderate pain Weak analgesic most effective when used with NSAIDs, aspirin, or acetaminophen This drug is not recommended in the elderly Will cause carbamazepine levels to increase 100 mg of napsylate salt = 65 mg of HCI salt Third-line agent for moderate-to-severe pain... 

Use with salicylates is not recommended. The use of aspirin with nonsteroidal anti-inflammatory agents (NSAIDs) may cause a decrease in blood levels of the nonaspirin drug. 

Concomitant use with NSAiDs - Ketorolac is contraindicated in patients currently receiving aspirin or other NSAIDs ketorolac also is contraindicated with the concomitant use of probenecid. 

Type B effects are not related to the pharmacological properties of these drugs. Serious side effects may occur. Allergic skin and liver reactions to aspirin and paracetamol have been reported with risk of fibrosis, particularly in the retroperitoneal region for methysergide and hypersensitivity reactions with NSAID and pure analgesics. 

Tolmetin (Tolectin) is an antiinflammatory, analgesic, and antipyretic agent that produces the usual gastric distress and ulceration observed with NSAIDs. However, tolmetin is better tolerated than aspirin and produces less tinnitus and vertigo. Tolmetin is a substitute for indomethacin in indomethacin-sensitive patients and is unique among such drugs in that it can be used to treat juvenile arthritis. 

Patients with aspirin sensitivity should avoid aspirin and NSAIDs while taking mon-telukast... 

For patients with ulcers caused by aspirin or other NSAIDs, either H2 antagonists or proton pump inhibitors provide rapid ulcer healing so long as the NSAID is discontinued however continued use of the NSAID impairs ulcer healing. In patients with NSAID-induced ulcers who require continued NSAID therapy, treatment with a once- or twice-daily proton pump inhibitor more reliably promotes ulcer healing. 

The best representative of an NSAID is aspirin (acetylsalicylic acid Fig. 15-1). Newer NSAIDs are usually compared to aspirin in terms of efficacy and safety. Acetaminophen is another agent that is similar to aspirin and other NSAIDs in its ability to decrease pain and fever. Acetaminophen, however, is not considered an NSAID because it lacks anti-inflammatory and anticoagulant properties. For a discussion of the comparative effects of aspirin, newer NSAIDs, and acetaminophen, see Comparison of Aspirin with Other NSAIDs. ... 

Aspirin is the oldest and most widely used NSAID, and other NSAIDs are compared with aspirin in terms of efficacy and safety. Hence, this discussion focuses primarily on the clinical applications of aspirin and the problems typically associated with aspirin. For the most part, clinical use and problems can also be applied to most nonaspirin NSAIDs. The major similarities and differences between aspirin and the other NSAIDs are discussed in Comparison of Aspirin with Other NSAIDs. ... 

Rheumatoid arthritis and osteoarthritis represent two distinct forms of joint disease that can produce devastating effects on the structure and function of synovial joints. Fortunately, management of these conditions has improved substantially through advancements in drug therapy. Rheumatoid arthritis can be treated pharmacologically with NSAIDs, glucocorticoids, and various DMARDs. NSAIDs, including aspirin, repre-... 

Weak analgesic use with NSAIDs, aspirin, or acetaminophen... 

ACE INHIBITORS, ANGIOTENSIN II RECEPTOR ANTAGONISTS ASPIRIN t risk of renal impairment. 1 efficacy of captopril and enalapril with high-dose (>100mg/day) aspirin Aspirin and NSAIDs can cause elevation of BP. Prostaglandin inhibition leads to sodium and water retention and poor renal function in those with impaired renal blood flow Monitor renal function every 3-6 months watch for poor response to ACE inhibitors when >100mg/day aspirin is given... 

ASPIRIN ANALGESICS - NSAIDs 1. Risk of gastrointestinal bleeding when aspirin, even a low dose, is co-administered with NSAIDs 2. Ibuprofen 1 antiplatelet effect of aspirin 1. Additive effect 2. Ibuprofen competitively inhibits binding of aspirin to platelets 1. Avoid co-administration 2. Avoid co-administration... 

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