Study Warns of Mixing Ibuprofen with Aspirin

Painkiller combo may spell trouble for heart patients

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HealthDay Reporter

THURSDAY, Feb. 13, 2003 (HealthDayNews) -- New research suggests that ibuprofen, a common over-the-counter painkiller, could kill heart patients who combine it with aspirin.

A study of 7,107 patients in the United Kingdom found that those who took aspirin and ibuprofen had much higher death rates than those who took another aspirin-painkiller combination or just aspirin itself.

Frequent treatment with ibuprofen "might chronically prevent the good effects of aspirin," said study co-author Dr. Thomas M. MacDonald, a professor of clinical pharmacology at Ninewells Hospital and Medical School in Dundee, Scotland. Ibuprofen is sold as Advil, Motrin-IB, Ibuprin, and Nuprin in the United States.

The good news is that other painkillers, such as acetaminophen (Tylenol), seem not to create health problems when taken with aspirin, MacDonald said. "There is a lot to chose from, but this should be done on the advice of a physician," he added.

The study doesn't knock the use of aspirin, which makes blood less "sticky" and less likely to form obstructions in arteries. For these reasons, aspirin appears to reduce the risk of heart attack and stroke, MacDonald said. Doctors frequently advise heart patients and healthy people to take small doses of aspirin each day.

While aspirin reduces pain from inflammation in addition to helping the heart, it isn't effective against other types of pain and soreness. Some people turn to ibuprofen, which works to combat back pain, arthritis and general muscular aches and pains, MacDonald said.

But a small American study in The New England Journal of Medicine in 2001 suggested that ibuprofen may zap the blood-thinning properties of aspirin. Even when patients took ibuprofen throughout the day and aspirin only in the morning, the ibuprofen appeared to make aspirin less beneficial.

MacDonald said he and colleagues wanted to expand on the results of the earlier study by examining death rates. They looked at 7,107 heart disease patients who were discharged from hospitals and took home prescriptions for low doses of aspirin.

They report their findings in the Feb. 15 issue of The Lancet.

The 187 patients who were prescribed both aspirin and ibuprofen were about twice as likely to die of any cause as patients who just took aspirin. They also suffered a 75 percent boost in their risk of dying from heart disease.

Taken together, the two drugs "are much worse than either individually," MacDonald said. "There is more risk of bleeding with the combination. It's a double whammy -- not so much benefit and more risk of side effects."

Patients who took aspirin and the painkiller dicloflenec, known as Cataflam or Voltaren, didn't suffer higher death rates. Neither did people who took aspirin and other types of medications known as nonsteroidal anti-inflammatory drugs (NSAIDS).

The co-author of a previous study into the aspirin-ibuprofen combo said heart patients should ask their doctor if they need to take aspirin and an NSAID. Ibuprofen is in that class of drugs, along with a variety of other less well-known painkillers.

"Broadly, it appears a choice other than ibuprofen would seem desirable," said the co-author, Dr. Garrett FitzGerald, chairman of the pharmacology department at the University of Pennsylvania.

But patients who take ibuprofen in addition to aspirin on an occasional basis shouldn't be at risk, he said.

More information

Learn about the variety of painkillers you can take and why some are better than others for specific conditions in this Mayo Clinic round-up. For an explanation of how NSAIDs and analgesics work, try Pharmacology Central.

SOURCES: Thomas M. MacDonald, M.D., medicines monitoring unit, department of clinical pharmacology and therapeutics, Ninewells Hospital and Medical School, University of Dundee, Scotland; Garrett FitzGerald, M.D., chairman, pharmacology department, University of Pennsylvania, Philadelphia; Feb. 15, 2003, The Lancet

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