ASPIRIN Drug Interactions
Also known as: Aspirin Regular Strength
ASPIRIN (brand name: Aspirin Regular Strength) is a NSAIDs. Uses temporarily relieves: headache muscle pain toothache menstrual pain pain and fever of colds minor pain of arthritisASPIRIN has 18 documented drug interactions in our database, including 0 contraindicated, 16 major, 2 moderate, and 0 minor interactions.
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Contraindicated
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Moderate
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Minor
Taking multiple forms of aspirin, such as regular aspirin and aspirin 81 mg, at the same time can significantly increase your risk of bleeding, including serious stomach bleeding.
Mechanism
Both regular aspirin and aspirin 81 mg contain the same active ingredient, aspirin. Aspirin inhibits platelet aggregation irreversibly and also has NSAID properties. Taking both products concurrently leads to an additive antiplatelet effect and increased gastrointestinal irritation, significantly elevating the risk of bleeding.
Clinical Management
The primary clinical effect is an increased risk of bleeding, particularly gastrointestinal bleeding (e.g., stomach ulcers, hemorrhage), which can be severe and life-threatening. Symptoms may include black, tarry stools, vomiting blood, or unusual bruising. The risk of GI bleeding can be 3-15 times higher when NSAIDs are combined with other antiplatelets/anticoagulants, and this scenario represents an overdose of aspirin's antiplatelet effect. Patients should be advised to avoid taking multiple aspirin-containing products simultaneously. If aspirin is prescribed for antiplatelet therapy (e.g., 81 mg), other NSAIDs or aspirin products should be avoided unless specifically directed by a physician. Monitor for signs of bleeding and consider gastroprotective agents if high-dose aspirin is unavoidable.
Combining aspirin with apixaban significantly increases your risk of bleeding, including serious internal bleeding. Your doctor will weigh the benefits against this high risk.
Mechanism
Aspirin, particularly at higher doses, inhibits platelet aggregation and can cause gastrointestinal irritation. Apixaban directly inhibits Factor Xa, preventing clot formation. The concurrent use of these agents leads to a synergistic impairment of hemostasis, significantly increasing the risk of bleeding.
Clinical Management
The primary clinical effect is a substantially increased risk of hemorrhage, including gastrointestinal bleeding, intracranial hemorrhage, and other major bleeding events. Studies show a significantly higher rate of major bleeding with combined therapy compared to either drug alone, potentially increasing major bleeding risk by 2-3 times. Concurrent use should generally be avoided unless the cardiovascular benefit clearly outweighs the bleeding risk, such as in specific high-risk cardiovascular conditions. If co-administration is deemed necessary, use the lowest effective dose of aspirin (e.g., 81 mg) and monitor patients closely for signs of bleeding. Consider gastroprotective agents like proton pump inhibitors.
Combining aspirin with rivaroxaban significantly increases your risk of serious bleeding, including bleeding in the stomach or brain. This combination should generally be avoided unless specifically directed and closely monitored by your doctor.
Mechanism
Aspirin is an antiplatelet agent that irreversibly inhibits cyclooxygenase (COX-1), reducing thromboxane A2 production and impairing platelet aggregation. Rivaroxaban is a direct oral anticoagulant (DOAC) that directly inhibits Factor Xa, preventing thrombin generation and clot formation. The concurrent use of these agents leads to a synergistic inhibition of both primary hemostasis (platelet function) and secondary hemostasis (coagulation cascade), resulting in a substantially elevated risk of hemorrhage.
Clinical Management
The primary clinical effect is a significantly increased risk of bleeding, which can range from minor events like bruising and nosebleeds to severe, life-threatening hemorrhages such as gastrointestinal bleeding, intracranial hemorrhage, or retroperitoneal bleeding. Studies have shown that combining NSAIDs with DOACs can increase the risk of major bleeding by 2 to 3 times compared to DOAC monotherapy. This combination should generally be avoided due to the high bleeding risk. If concurrent use is deemed absolutely necessary (e.g., for specific cardiovascular indications), it must be done under strict medical supervision with careful monitoring for signs of bleeding. Consider alternative pain management options if aspirin is for analgesia. If aspirin is for antiplatelet therapy, reassess the absolute need and duration, and consider lowest effective doses. Patient education on bleeding symptoms is crucial.
Combining aspirin with argatroban significantly increases your risk of bleeding, including serious internal bleeding. This combination should generally be avoided unless the benefits clearly outweigh the very high risks.
Mechanism
Aspirin inhibits platelet aggregation irreversibly by blocking cyclooxygenase-1 (COX-1), reducing thromboxane A2 production. Argatroban is a direct thrombin inhibitor, preventing thrombin's procoagulant effects. The concurrent use of an antiplatelet agent and an anticoagulant leads to additive impairment of hemostasis.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding. This can manifest as easy bruising, nosebleeds, gum bleeding, or more severe events like gastrointestinal bleeding, intracranial hemorrhage, or hematuria. The risk of major bleeding is significantly elevated compared to either drug alone. This combination should be avoided if possible. If concomitant use is deemed absolutely necessary due to critical indications for both drugs, patients require extremely close monitoring for signs of bleeding. Consider alternative therapies or dose adjustments under strict medical supervision. Patient education on bleeding symptoms is crucial.
Combining aspirin with bivalirudin significantly increases your risk of bleeding, including serious internal bleeding. Your healthcare provider will carefully weigh the benefits and risks of this combination.
Mechanism
Aspirin exerts antiplatelet effects by irreversibly inhibiting cyclooxygenase-1 (COX-1), preventing thromboxane A2 formation and platelet aggregation. Bivalirudin is a direct thrombin inhibitor, preventing thrombin's role in fibrin formation and platelet activation. The concurrent use leads to additive inhibition of primary hemostasis and coagulation cascade, profoundly increasing bleeding risk.
Clinical Management
The primary clinical effect is a significantly increased risk of bleeding, which can range from minor bruising and epistaxis to major hemorrhage, including gastrointestinal bleeding, intracranial hemorrhage, or retroperitoneal bleeding. The risk of major bleeding with dual antiplatelet therapy (like aspirin) and an anticoagulant can be several-fold higher compared to anticoagulant monotherapy. This combination should be avoided if possible due to the high bleeding risk. If concurrent use is deemed absolutely necessary (e.g., during percutaneous coronary intervention), patients must be closely monitored for signs of bleeding, and the duration of dual therapy should be minimized. Dose adjustments of one or both agents may be considered, and proton pump inhibitors may be co-administered to reduce gastrointestinal bleeding risk.
Combining aspirin with warfarin significantly increases your risk of serious bleeding, including stomach bleeding, which can be life-threatening. Avoid this combination unless specifically directed and closely monitored by your doctor.
Mechanism
Aspirin inhibits platelet aggregation and can cause gastric irritation, while warfarin inhibits vitamin K-dependent clotting factors. The concurrent use leads to a synergistic anticoagulant effect, impairing both primary hemostasis (platelet plug formation) and secondary hemostasis (clotting cascade). This combined effect drastically elevates the risk of hemorrhage.
Clinical Management
Patients taking both aspirin and warfarin have a substantially increased risk of gastrointestinal bleeding (3-15 times higher), intracranial hemorrhage, and other major bleeding events. This interaction can also lead to an elevated International Normalized Ratio (INR), indicating excessive anticoagulation. Bleeding can range from bruising and nosebleeds to severe, life-threatening internal hemorrhages. This combination should generally be avoided due to the high risk of major bleeding. If co-administration is deemed absolutely necessary (e.g., for specific cardiac conditions), it must be under strict medical supervision with frequent INR monitoring and close observation for any signs of bleeding. Proton pump inhibitors may be considered to reduce gastrointestinal bleeding risk, and alternative antiplatelet or anticoagulant therapies should be explored.
Combining aspirin with dabigatran significantly increases your risk of bleeding, including serious internal bleeding. This combination should generally be avoided unless specifically recommended and closely monitored by your doctor.
Mechanism
Aspirin, even at low doses, inhibits platelet aggregation through irreversible cyclooxygenase-1 (COX-1) inhibition, reducing the blood's ability to clot. Dabigatran directly inhibits thrombin, a key enzyme in the coagulation cascade, also preventing clot formation. The concurrent use of these agents results in an additive antiplatelet and anticoagulant effect, leading to a substantially increased risk of bleeding.
Clinical Management
The primary clinical effect is a heightened risk of bleeding, which can manifest as bruising, nosebleeds, gum bleeding, or more severe events like gastrointestinal bleeding, intracranial hemorrhage, or hematuria. The risk of major bleeding with this combination is significantly elevated compared to either drug alone, potentially increasing 2 to 3-fold. This combination should generally be avoided due to the high bleeding risk. If concurrent use is deemed absolutely necessary (e.g., for specific cardiovascular indications), it must be done under strict medical supervision with careful monitoring for bleeding signs and symptoms. Consider alternative antiplatelet agents if aspirin is not essential, or evaluate if the dabigatran dose can be adjusted. Patient education on bleeding precautions is crucial.
Combining aspirin with edoxaban significantly increases your risk of bleeding, including serious internal bleeding. Your doctor will need to carefully weigh the benefits and risks of this combination.
Mechanism
Aspirin inhibits platelet aggregation, primarily by irreversibly acetylating cyclooxygenase-1 (COX-1), which reduces thromboxane A2 production. Edoxaban is a direct oral anticoagulant that selectively inhibits factor Xa, preventing thrombin generation and clot formation. The concurrent use of these agents results in additive antiplatelet and anticoagulant effects, leading to a synergistic increase in bleeding risk.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding. This includes minor bleeding (e.g., bruising, nosebleeds, gum bleeding) and major bleeding events such as gastrointestinal hemorrhage, intracranial hemorrhage, or other internal bleeding. Studies show that combining NSAIDs with DOACs can increase the risk of major bleeding by 2 to 3-fold compared to DOACs alone, with GI bleeding being particularly common. This combination should generally be avoided due to the high bleeding risk. If concurrent use is deemed absolutely necessary, it should be for the shortest possible duration and with extreme caution, requiring close monitoring for signs of bleeding. Consider alternative pain management strategies that do not increase bleeding risk. Patients should be educated on bleeding symptoms and advised to seek immediate medical attention if they occur.
Combining aspirin with heparin significantly increases your risk of bleeding, including serious internal bleeding. Your healthcare provider will carefully weigh the benefits against this increased risk.
Mechanism
Aspirin inhibits platelet aggregation irreversibly by acetylating cyclooxygenase-1 (COX-1), reducing thromboxane A2 production, which impairs primary hemostasis. Heparin exerts its anticoagulant effect by potentiating antithrombin, leading to inactivation of thrombin and factor Xa. The concurrent use of these agents results in additive antiplatelet and anticoagulant effects, severely compromising the body's ability to form clots.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding, which can manifest as gastrointestinal bleeding (e.g., ulcers, melena), intracranial hemorrhage, hematuria, epistaxis, or easy bruising. The risk of major bleeding is significantly elevated, potentially leading to anemia, shock, or death. This combination can increase the risk of serious bleeding by 3 to 15 times compared to either drug alone. Avoid concurrent use if possible. If co-administration is unavoidable, close monitoring for signs and symptoms of bleeding (e.g., blood in stool, unusual bruising, dizziness) is essential. Consider lower doses of one or both agents if clinically appropriate and monitor complete blood count (CBC) regularly. Patient education on bleeding precautions is critical, and immediate medical attention should be sought for any bleeding signs.
Combining aspirin with enoxaparin significantly increases your risk of bleeding, including serious internal bleeding. This combination should generally be avoided unless specifically directed and closely monitored by your doctor.
Mechanism
Aspirin inhibits platelet aggregation irreversibly through cyclooxygenase-1 (COX-1) inhibition, reducing the blood's ability to clot. Enoxaparin, a low molecular weight heparin, directly inhibits Factor Xa, further impairing the coagulation cascade. The additive antiplatelet and anticoagulant effects lead to a synergistic increase in bleeding risk.
Clinical Management
Patients are at a substantially increased risk of bleeding, including gastrointestinal bleeding, intracranial hemorrhage, and other major bleeding events. The risk of major bleeding can be several-fold higher compared to using either drug alone, potentially leading to hospitalization or life-threatening consequences. This combination should generally be avoided due to the high bleeding risk. If concurrent use is absolutely necessary, such as for specific cardiovascular indications, patients require extremely close monitoring for signs of bleeding (e.g., black/tarry stools, unusual bruising, nosebleeds). Gastroprotective agents (e.g., PPIs) may be considered, and the lowest effective doses of both drugs should be used for the shortest possible duration. Regular assessment of complete blood count is recommended.
Combining aspirin with fondaparinux significantly increases your risk of bleeding, including serious internal bleeding. Your doctor should carefully weigh the benefits against this increased risk.
Mechanism
Aspirin inhibits platelet aggregation irreversibly by blocking cyclooxygenase-1 (COX-1), leading to reduced thromboxane A2 production. Fondaparinux is a selective Factor Xa inhibitor, preventing thrombin generation and clot formation. The concomitant use of these agents results in additive antiplatelet and anticoagulant effects, severely impairing the body's ability to form clots.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding, which can range from minor bruising or nosebleeds to severe gastrointestinal hemorrhage, intracranial bleeding, or other major bleeding events. This combination can increase the risk of serious bleeding by several fold compared to either drug alone, potentially leading to hospitalization or death. This combination should generally be avoided due to the high bleeding risk. If co-administration is deemed absolutely necessary, such as in specific high-risk cardiovascular conditions, patients require very close monitoring for signs of bleeding (e.g., blood in stool, dark tarry stools, unusual bruising, dizziness). Consider alternative therapies or dose adjustments if possible, and educate the patient on bleeding precautions.
Combining aspirin and dipyridamole significantly increases your risk of bleeding, including serious stomach or intestinal bleeding, due to their combined effects on blood clotting.
Mechanism
Both aspirin and dipyridamole inhibit platelet aggregation, albeit through different mechanisms. Aspirin irreversibly inhibits cyclooxygenase-1 (COX-1), preventing thromboxane A2 production, while dipyridamole inhibits phosphodiesterase, increasing cyclic AMP and reducing platelet adhesion. Their additive antiplatelet effects lead to a heightened risk of hemorrhage.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding. This includes gastrointestinal bleeding (e.g., peptic ulcer, melena, hematemesis), intracranial hemorrhage, epistaxis, and bruising. The risk of major bleeding is significantly elevated compared to monotherapy, potentially increasing 2-3 fold. This combination should generally be avoided unless the benefits clearly outweigh the risks and under close medical supervision. If co-administration is deemed necessary, monitor patients closely for signs of bleeding, such as black stools, unusual bruising, or prolonged bleeding from cuts. Consider proton pump inhibitor co-therapy to mitigate GI bleeding risk, and use the lowest effective doses of both medications.
Combining aspirin and ticagrelor significantly increases your risk of bleeding, especially in the stomach and intestines. Your doctor will carefully weigh the benefits against this increased risk.
Mechanism
Aspirin, even at low doses, inhibits platelet aggregation irreversibly by blocking cyclooxygenase-1 (COX-1), reducing thromboxane A2 production. Ticagrelor is a direct-acting, reversible P2Y12 platelet inhibitor. The concurrent use of two antiplatelet agents results in additive antiplatelet effects, severely impairing the body's ability to form clots.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding, particularly gastrointestinal bleeding, but also includes intracranial hemorrhage and other major bleeding events. This combination can increase the risk of major bleeding by 2-3 fold compared to ticagrelor alone, and the risk of gastrointestinal bleeding is particularly high. This combination is often prescribed for specific cardiovascular conditions (e.g., acute coronary syndrome) where the antiplatelet benefits outweigh the bleeding risk. Close monitoring for signs of bleeding (e.g., black/tarry stools, unusual bruising, prolonged bleeding from cuts) is essential. Proton pump inhibitors (PPIs) may be co-prescribed to reduce gastrointestinal bleeding risk. Do not stop either medication without consulting your doctor.
Combining aspirin and clopidogrel significantly increases your risk of bleeding, especially from the stomach or intestines. Your doctor will weigh the benefits of preventing blood clots against this serious bleeding risk.
Mechanism
Both aspirin and clopidogrel inhibit platelet aggregation through different pathways, leading to a synergistic antiplatelet effect. Aspirin irreversibly inhibits cyclooxygenase (COX-1), reducing thromboxane A2 production, while clopidogrel is a prodrug that irreversibly blocks the P2Y12 ADP receptor on platelets. This dual inhibition severely impairs the body's ability to form clots.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding, particularly gastrointestinal bleeding, which can be severe or even fatal. Studies have shown that dual antiplatelet therapy (DAPT) with aspirin and clopidogrel increases the risk of major bleeding by 50-100% compared to clopidogrel alone, and significantly higher than aspirin alone. This includes an elevated risk of intracranial hemorrhage. This combination should be used with extreme caution and only when the benefits of preventing thrombotic events (e.g., after stent placement) clearly outweigh the bleeding risks. Patients should be closely monitored for signs of bleeding (e.g., black/tarry stools, unusual bruising, nosebleeds). Proton pump inhibitors (PPIs) may be co-administered to reduce GI bleeding risk. The duration of DAPT should be as short as clinically necessary.
Combining aspirin with prasugrel significantly increases your risk of bleeding, including serious and life-threatening bleeding episodes, because both medications thin your blood.
Mechanism
Aspirin irreversibly inhibits cyclooxygenase-1 (COX-1), preventing thromboxane A2 production and platelet aggregation. Prasugrel is a prodrug that, once metabolized, irreversibly binds to the P2Y12 receptor on platelets, inhibiting ADP-induced platelet activation and aggregation. The concurrent use of two antiplatelet agents leads to a synergistic inhibition of platelet function.
Clinical Management
This combination substantially elevates the risk of bleeding, including gastrointestinal bleeding, intracranial hemorrhage, and other major bleeding events. Patients may experience bruising, nosebleeds, blood in urine or stool, or prolonged bleeding from cuts. The risk of major bleeding can be several-fold higher compared to monotherapy. Avoid concurrent use of aspirin and prasugrel unless the benefits clearly outweigh the risks, such as in specific acute coronary syndromes where dual antiplatelet therapy (DAPT) is indicated. If co-administration is unavoidable, monitor patients closely for signs of bleeding, perform regular blood counts, and educate them on bleeding precautions. Consider proton pump inhibitor co-therapy to reduce gastrointestinal bleeding risk.
Combining aspirin and cilostazol significantly increases your risk of bleeding, especially from the stomach or intestines. This combination should generally be avoided unless specifically recommended and closely monitored by your doctor.
Mechanism
Both aspirin and cilostazol exert antiplatelet effects through different mechanisms, leading to an additive inhibition of platelet aggregation. Aspirin irreversibly inhibits cyclooxygenase-1 (COX-1), reducing thromboxane A2 production, while cilostazol inhibits phosphodiesterase III (PDE3), increasing cyclic AMP and thereby reducing platelet activation. The combined effect profoundly impairs hemostasis.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding. This includes gastrointestinal bleeding (e.g., ulcers, hemorrhage), which can be severe and life-threatening, as well as increased risk of epistaxis, bruising, hematuria, and other bleeding events. The risk of major bleeding can be several-fold higher compared to monotherapy. This combination should generally be avoided due to the high bleeding risk. If concurrent use is deemed absolutely necessary by a specialist (e.g., for specific cardiovascular indications), patients must be monitored extremely closely for any signs of bleeding. Consider alternative therapies or dose adjustments if possible, and ensure a proton pump inhibitor (PPI) is prescribed for gastroprotection.
Ibuprofen can interfere with the antiplatelet effect of low-dose aspirin, which is used for cardiovascular prophylaxis. This interaction may reduce aspirin's ability to prevent blood clots, potentially increasing the risk of cardiovascular events.
Mechanism
Ibuprofen, by reversibly binding to the cyclooxygenase-1 (COX-1) enzyme, can block aspirin's irreversible binding site. If ibuprofen is taken before aspirin, it prevents aspirin from acetylating COX-1 in platelets, thereby diminishing aspirin's antiplatelet effect.
Clinical Management
To minimize this interaction, patients taking low-dose aspirin for cardiovascular protection should take ibuprofen at least 30 minutes after or 8 hours before their daily aspirin dose. If frequent ibuprofen use is necessary, alternative analgesics like acetaminophen or other NSAIDs that do not interfere with aspirin's antiplatelet effect (e.g., celecoxib) should be considered.
High-dose aspirin combined with celecoxib negates celecoxib's GI safety advantage and increases GI bleeding risk.
Mechanism
Aspirin inhibits COX-1-mediated prostaglandin production in the GI mucosa, removing the protective benefit of selective COX-2 inhibition.
Clinical Management
If low-dose aspirin (≤81 mg) for cardiovascular prophylaxis is required with celecoxib, add a PPI for GI protection.
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