Effect of ibuprofen on cardioprotective effect of aspirin

Abstract

The hypothesis by T M MacDonald and L Wei1MacDonald TM Wei L Effect of ibuprofen on cardioprotective effect of aspirin.Lancet. 2003; 361: 573-574Summary Full Text Full Text PDF PubMed Scopus (416) Google Scholar that ibuprofen may interact with the cardioprotective effect of aspirin accords with the current understanding of clinical pharmacology of aspirin and non-steroidal anti-inflammatory drugs (NSAIDS). However, the enigma of interaction between aspirin and NSAIDs, or adverse reaction of NSAID, is not yet solved. The major serious adverse effect of treatment with aspirin plus NSAIDs is gastrointestinal bleeding.2British National Formulary. British Medical Association, Royal Pharmaceutical Society of Great Britain, LondonMarch, 2002Google Scholar Furthermore, ibuprofen and NSAIDs promote the retention of salt and water, antagonise the action of diuretics, and reduce the effectiveness of antihypertensive regimens.2British National Formulary. British Medical Association, Royal Pharmaceutical Society of Great Britain, LondonMarch, 2002Google Scholar, 3Ray WA Stein CM Daugherty JR et al.COX-2 selective non-steroidal drugs and risk of serious coronary heart disease.Lancet. 2002; 360: 1071-1073Summary Full Text Full Text PDF PubMed Scopus (490) Google Scholar I have observed pronounced weight increase and distinct oedemas in non-cardiac patients (mostly women) within 2–3 days after start of NSAID treatment.4Jerie P Water retention caused by pyrazolidine drugs.Prakt Lek. 1968; 48: 27-28Google Scholar The seriousness of the sodium retaining effect was recognised and briefly described 50 years ago by J M Johnston.5Johnston JM Phenylbutazone and water retention.JAMA. 1953; 152: 75Crossref Scopus (1) Google Scholar Each of his seven patients with rheumatoid or gouty arthritis, aged 38–84 years, received 200 mg phenylbutazone four times daily. None of them had significant cardiovascular or renal limitations and all of them were instructed to restrict the amount of salt in their diet. All seven patients became dyspnoeic and developed peripheral oedema within 10–20 days.5Johnston JM Phenylbutazone and water retention.JAMA. 1953; 152: 75Crossref Scopus (1) Google Scholar Now, although this story may sound anecdotal, questions about aspirin and aspirin-like drugs have not yet been satisfactorily resolved. The negative effect of ibuprofen on the cardio-protective properties of aspirin might be an adverse reaction of an NSAID, not an interaction causing aspirin inactivity or resistance. Effect of ibuprofen on cardioprotective effect of aspirinAuthors' reply Full-Text PDF