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Senior Citizen Health & Medicine
Senior Citizens Taking Ibuprofen for Pain, Aspirin
for Stroke are at Risk
‘…interaction between aspirin and ibuprofen… one of
the best-known, but well-kept secrets in stroke medicine’
Brand names for ibuprofen include Advil, Motrin,
Genpril, Haltran, IBU, Menadol and Midol. There are other combination
products that contain ibuprofen. |
March 13, 2008 – Many senior citizens fight pain –
often from arthritis – with ibuprofen (Advil, Motrin, etc.). At the same
time, many of these seniors are taking aspirin to reduce the risk of a
second stroke, and other cardiovascular problems. It’s not working. A
new study confirms that ibuprofen undermines aspirin’s ability to act as
an anti-platelet agent, say researchers at the University of Buffalo.
In a cohort of patients seen by physicians at two
offices of the Dent Neurologic Institute, 28 patients were identified as
taking both aspirin and ibuprofen (a nonsteroidal anti-inflammatory
drug, or NSAID) daily and all were found to have no anti-platelet effect
from their daily aspirin.
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Thirteen of these patients were being seen because
they had a second stroke/TIA while taking aspirin and a NSAID, and were
platelet non-responsive to aspirin (aspirin resistant) at the time of
that stroke.
The researchers found that when 18 of the 28
patients returned for a second neurological visit after discontinuing
NSAID use and were tested again, all had regained their aspirin
sensitivity and its ability to prevent blood platelets from aggregating
and blocking arteries.
The study is the first to show the clinical
consequences of the aspirin/NSAID interaction in patients being treated
for prevention of a second stroke, and presents a possible explanation
of the mechanism of action.
The Food and Drug Administration currently warns
that ibuprofen might make aspirin less effective, but states that the
clinical implications of the interaction have not been evaluated.
"This interaction between aspirin and ibuprofen or
prescription NSAID's is one of the best-known, but well-kept secrets in
stroke medicine," said Francis M. Gengo, Pharm.D., lead researcher on
the study.
"It's unfortunate that clinicians and patients
often are unaware of this interaction. Whatever number of patients, who
have had strokes because of the interaction between aspirin and NSAIDs,
those strokes were preventable."
Gengo is professor of neurology in the UB School of
Medicine and Biomedical Sciences and professor of pharmacy practice in
the UB School of Pharmacy and Pharmaceutical Sciences. Results of the
study were published in the January issue of the Journal of Clinical
Pharmacology.
"We first looked at this issue way back in 1992 in
a study conducted in normal volunteers, but it was published as an
abstract only," he said.
"We never followed through with a manuscript, but
another group published an elegant study in the New England Journal of
Medicine showing this interaction at least seven years ago.
"When we began to assess this in our stroke
patients, a surprisingly high percentage of a group of 653 patients,
around 17 percent, were taking aspirin plus Motrin (a brand of
ibuprofen).
"The prescription medication Aggrenox, which also
is used for secondary stroke prevention and contains aspirin and
extended release dipyridamole, is affected the same way as aspirin,"
Gengo continued.
"In preventing strokes, it is statistically a
little better than aspirin but more expensive.
"However, one of the most common side effects when
you first start taking Aggrenox is headache, so some physicians,
pharmacists or physician assistants tell patients to take a Motrin so
they don't get a headache. This likely would negate the effects of the
aspirin and extended release dipyridamole. Those patients might as well
take this expensive drug and flush it down the toilet."
Gengo and colleagues verified with urine testing
that all 18 patients, six men and 12 women, were taking their aspirin or
aspirin and extended release dipyridamole as directed. Information on
the concomitant use of NSAIDS was obtained from patient interviews.
Data
from the earlier healthy volunteer study showed the magnitude and time
course of each drug administered separately, as well as in combination.
The UB study provides important information, Gengo
noted, because in most previous studies, measurements were taken only at
one point in time, and that time point may have been during the 4-6 hour
window when concentrations of NSAIDS were sufficiently high to inhibit
aggregation.
"Our data report the entire time course of this
interaction," he said. "The results showed that platelets resumed
aggregating within 4-6 hours when aspirin and ibuprofen were taken close
together, leaving patients with no anti-platelet effect for 18-20 hours
a day. Normally, a single dose of aspirin has an effect on platelet
aggregation for 72-96 hours," Gengo said.
"When I lecture to pharmacy students, I tell them
'Please, you have a responsibility to the patients you care for. When
you counsel a patient taking aspirin/extended release dipyrdamole to
lower stroke risk, tell patients they may have some transient headaches,
but to avoid ibuprofen. You may have prevented that patient from having
another stroke.'"
This study was supported by the Dent Family
Foundation.
UB/Dent personnel who also contributed to the study
were Michelle Rainka, Pharm.D., UB adjunct instructor of pharmacy
practice; Donald E. Mager, Pharm.D., UB assistant professor of
pharmaceutical sciences, and Vernice Bates, M.D., UB clinical associate
professor of neurology. Matthew Robson and Michael Gengo, research
assistants at the Dent Neurologic Institute, and Lisa Rubin, Pharm.D., a
former UB student, also contributed to the research.
The University at Buffalo is a premier
research-intensive public university, a flagship institution in the
State University of New York system and its largest and most
comprehensive campus. UB's more than 28,000 students pursue their
academic interests through more than 300 undergraduate, graduate and
professional degree programs. The School of Medicine and Biomedical
Sciences, School of Dental Medicine, School of Nursing, School of
Pharmacy and Pharmaceutical Sciences and School of Public Health and
Health Professions are the five schools that constitute UB's Academic
Health Center. Founded in 1846, the University at Buffalo is a member of
the Association of American Universities.
More About Ibuprofen
(eye byoo' proe fen)
The page on ibuprofen at MedlinePlus, the medical
information site of the National Institutes of Health, starts with a
warning:
“People who take nonsteroidal anti-inflammatory
medications (NSAIDs) (other than aspirin) such as ibuprofen may have a
higher risk of having a heart attack or a stroke than people who do not
take these medications. These events may happen without warning and may
cause death.
"This risk may be higher for people who take NSAIDs for a
long time. Tell your doctor if you or anyone in your family has or has
ever had heart disease, a heart attack, or a stroke, if you smoke,a nd if
you have or have ever had high cholesterol, high blood pressure, or
diabetes.
Get emergency medical help right away if you experience any of
the following symptoms: chest pain, shortness of breath, weakness in one
part or side of the body, or slurred speech.”
>>
Read more on Ibuprofen at MedlinePlus
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