Aspirin and ibuprofen bad combo?

[Blackheartednurse]

My patient takes aspirin daily but then decided to buy Advil (without my knowledge even though MD added Tylenol as PRN just in case the pain is not relieved by a her daily pain med which Meloxicam.I checked and it looks like asprin and advil are not a great combo since there is an icrease risk for bleeding anybody else wants to add to the opinion?

[nerdtonurse?, BSN, RN]

How much, how often, and do they have any GI bleed history or use of coumadin, on chemo...? I had one doc who would prescribe a tylenol/advil combo, he said the 2 together worked better than either apart, but since tylenol doesn't do a thing for me in terms of pain control, I can't speak to that from personal information. I'm interested in this one, too.

[canesdukegirl, BSN, RN]

Yes, taking aspirin and ibuprofen will subject the user to an increased risk of bleeding. However, taking Ibuprofen and Tylenol will not, to my knowledge do the same.

[TiffyRN, BSN, PhD]

Aspirin + Advil + Meloxicam (another NSAID) is high risk for bleeding & GI distress/ulceration. I had a patient as a student that demonstrated this. He broke his ankle, was placed on prescription strength ibuprofen, didn't get enough relief so he took lots of extra BC powders (has ASA in it), plus he was a smoker & liked his drinks. At the point I met him, he was s/p emergency surgery for perforated gastric ulcer.

[caliotter3]

Advil and Tylenol are often prescribed to alternate with each other, particularly for peds patients. Haven't heard of aspirin being prescribed so much for pain anymore.

[rn/writer, RN]

We regularly combine Tylenol-containing meds (Percocet, Darvocet, etc.) with ibuprofen for c-section patients when they first come off their PCA or duramorph. Very effective as the two meds together cover incisional pain, cramping, and inflammation. I have never seen ASA prescribed on our floor.

In fact, I can't tell you the last time I saw ASA prescribed for anything except 81 mg daily to prevent MI and 325 mg for incipient MI.

I keep children's aspirin (still think of it that way even though it's not recommended for kids now) in the house, but haven't had a bottle of adult strength aspirin around for years and years.

[tyvin, BSN, RN]

In my area when Tylenol and Ibuprofen are taken together or alternated it's called stacking. You can take them both because their pharmacokinetics are different from each other. Ibuprofen is an NSAID and Tylenol is a prostaglandin inhibitor which yes does utilize the cox inhibitors but not like the NSAIDs do. In fact we still aren't completely sure how Tylenol works so we lump it into the group of non-opioid analgesic.

I don't know anyone who prescribes ASA anymore except of course for the heart patients who use it routinely. ASA isn't used on kids anymore because of the risk of rosacea.

[rn/writer, RN]

I thought aspirin wasn't prescribed for children because of the risk of Reye's syndrome.

[ObtundedRN, BSN, RN]

I don't see any use for ASA except for the cardiac reasons. I don't think it does anything for pain. And if your patient is on Mobic, I would also question why he is taking another NSAID.

[merlee]

Hi there!

I am a cardiac patient, have some stents, and take Plavix and 81mg ASA. I also take 800mg IBU, 2-3 x/day for chronic pain, with all my docs' knowledge. And if I can't get comfortable at night due to my pain, I add a Vicodin, 5/325.

I do tend to bruise easily, but it is a trade-off for decent sleep. Is it the best combo - for me it is. If I took Vicodin during the day, I'd be afraid to drive due to the sleepiness.

[canesdukegirl, BSN, RN]

I thought aspirin wasn't prescribed for children because of the risk of Reye's syndrome.

You are correct. I have never heard of aspirin not being given to children because of the risk of rosacea.

[ayla2004, ASN, RN]

Asprin at 75mg as an antiplatlet or 300mg MI or ischemic stroke

asprin isn't treated as a NSAID at these levels

i have seen advil prescibed as well

and paracetamol(apap)

but never gave 2 NASIDS for pain at the same time