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Heart Beat: Take aspirin before ibuprofen, not after

Heart Beat

Take aspirin before ibuprofen, not after

If you take aspirin for your heart and ibuprofen for your aches and pains, try to take the aspirin first each day. That's what the FDA is recommending in a warning to consumers and health care professionals.

In 2003 we highlighted research suggesting that ibuprofen (Motrin, Advil, others) could block the heart-protecting action of aspirin. Subsequent work supporting this idea prompted the FDA to issue its warning in mid-September 2006.

Aspirin helps prevent heart attacks and the most common form of stroke by making platelets in the bloodstream less sticky and thus less likely to clump and form artery-blocking blood clots. It does this by sliding into the pocket of an enzyme called cyclooxygenase and handing over a few atoms of carbon, hydrogen, and oxygen. This transfer stops cyclooxygenase from making prostaglandin. Without prostaglandin, platelets can't make thromboxane A₂, the substance that makes them sticky.

It turns out that ibuprofen, and maybe some other nonsteroidal anti-inflammatory drugs (NSAIDs), also fit into the enzyme's pocket. If they're in there when aspirin tries to enter, they could block its way.

Blocking the way Aspirin's ability to make platelets less sticky starts with it fitting snugly into the pocket of an enzyme known as cyclooxygenase. Ibuprofen can block aspirin's entry into this pocket.

The interaction isn't a problem if you take ibuprofen only once in a while. But if you take it a few times a week or more often, try this: Take regular (uncoated) aspirin first, and wait at least 30 minutes before taking ibuprofen. If that's impossible, try to delay taking aspirin for at least 8 hours after taking ibuprofen. Whether you need to follow this schedule if you use coated (enteric) aspirin is still up in the air.

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Last updated:	November 07, 2006