Patient’s Resource and Almanac of Primary Care Medicine
Aspirin and Anti-inflammatory Medications
Consider the following typical scenario: You are one of the growing numbers of individuals who
takes an aspirin everyday on the advice of a healthcare provider because of its cardioprotective
properties. Then one day you sprain your ankle, and you consider taking a couple of over-the-
counter Advils or Aleves for a few days for its anti-inflammatory effects. Seems harmless
enough, but is it? Is it advisable to take an aspirin and an anti-inflammatory medication
Before answering this question, let’s first discuss the workings of “anti-inflammatory”
medicines. When a body tissue is injured or muscles overstretched causing pain, the injured cells
produce a chemical called “prostaglandin”. There are about 30 known prostaglandins that the
body can produce depending on which body system or organ is involved. These prostaglandins
act as a signal for other blood components to commence the inflammatory response that often
results in any combination of pain, swelling, and redness in the area, and perhaps fever.
However, in the cardiovascular system, when the inner wall of a blood vessel is disrupted by
cholesterol particles, plaque formation ensues. You don’t have pain, redness, swelling, or fever;
nonetheless, a different type of inflammatory cascade begins, and some of those 30
prostaglandins are released. This then signals the blood component called “platelets” to
congregate in that area.
Platelets are sticky for the purpose of patching up the disrupted blood vessel wall. The sticky
platelets along with the cholesterol particles then begin to glob up within the blood vessel’s
walls, eventually growing the plaque large enough to block the vessel entirely, a situation called
atherosclerosis or “hardening of the arteries.”
Aspirin is a potent anti-prostaglandin compound, which is why it works well as an analgesic in
cases of pain and swelling and antipyretic (fever reducer) in cases of fever. In terms of heart
health, the anti-prostaglandin effects make the above-discussed platelets less sticky, thereby less
likely to promote plaque formation. This is certainly advantageous for heart health, especially for
individuals who have already had a heart attack.
Now what about other anti-inflammatory medications, such as ibuprofen (Motrin or Advil) or
naproxen (Aleve)? Although their mode of action is different from that of aspirin, their ability to
minimize the symptoms of inflammation is similar. So why should there be a problem for
patients who take daily aspirin for cardiovascular health to take one of these other medications
on the same day as they take aspirin? The answer is that aspirin and other anti-prostaglandins
compete when taken too soon to each other. Aspirin’s beneficial effects thus are negated. In
other words, taking ibuprofen or naproxyn could block the beneficial anti-platelet effects of the
In addition, anti-inflammatories such as Motrin and Advil have been shown to increase the risk
of heart attack or stroke in anyone who already has coronary artery disease. Fortunately, for
some reason that is unclear, Aleve (naproxyn) has been shown to be much less risky than the
other anti-inflammatories in people with heart disease.
If your healthcare provider has prescribed aspirin as part of your heart attack or stroke prevention
regimen and you find yourself in a situation where you would like to use an additional over-the-
counter anti-inflammatory agent, make sure you consult your prescriber first! A general rule of
thumb would be to separate aspirin and other anti-inflammatory medications by eight hours.
With occasional use, there is likely to be minimal risk of lessening the antiplatelet effect of
aspirin or increased risk for serious cardiac consequences. But what’s your definition of
Acetaminophen (Tylenol) is not an anti-platelet medication and probably would be better in
these situations. It is the same message that is preached over and over: Check with a nurse
practitioner, pharmacist, or physician before adding any medication to your daily prescribed
medications even if it is a presumably safe over-the-counter product.
Prostaglandin: Prostaglandins are highly potent substances produced by cell membranes in
virtually every body tissue. Some prostaglandins have been shown to participate in the
temperature-regulating mechanisms in the hypothalamus, thus producing fever; they also play a
part in contributing to inflammation. The fact that aspirin has been shown to inhibit
prostaglandin synthesis may account for its usefulness in decreasing fever and inflammation.
- Analgesic: A medication that relieves pain.
- Antipyretic: A medication that reduces fever.
- Anti-inflammatory: A medication that helps decrease pain, swelling, and other signs of inflammation.
- Platelets: Small, Small, round cell fragments found in the blood that function in clotting. Platelets contribute to the clotting process by adhering to damaged blood vessels and other platelets.
SOME DRUGS AND HERBS THAT MAY INCREASE OR DECREASE ASPIRIN’S EFFECTS.
*Fish oils and omega 3 fatty acids.
*Evening primrose oil.