Aspirin

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Jan 26, 2023

Warnings

Aspirin Risks, Warnings, and Complications

Aspirin can cause or worsen health conditions in some people. Talk to your doctor or pharmacist about other treatment options if you are at increased risk of complications from aspirin use.

GASTROINTESTINAL BLEEDING : Aspirin can cause irritation of the stomach lining. This can cause symptoms like stomach pain and heartburn. It can also lead to serious problems like excessive bleeding and ulcers in the stomach or intestines. The risk is greater in people who take other NSAIDs, a blood thinner like warfarin, or oral steroid medicines, which also increase bleeding risk. The risk of bleeding is also greater with the use of high-dose aspirin for a long time, alcohol use, and age over 60 years. Contact your doctor without delay if you experience stomach pain, bloody vomit, vomit that looks like coffee grounds, blood in the stools, or black or tarry stools (these can be signs of stomach bleeding or stomach ulcers).
KIDNEY DAMAGE: Higher doses of aspirin (325 mg or more) can cause kidney damage. The risk is particularly great in people with a history of kidney problems or liver problems or heart failure, people who are severely dehydrated, those over 65 years of age, and those who take certain blood pressure medications that can also damage the kidneys, such as ARBs (valsartan, losartan), ACE inhibitors (enalapril, lisinopril), and water pills. Stop taking aspirin and contact your healthcare provider if you notice any signs and symptoms of dehydration or kidney damage, such as decreased urination, fever, rapid heartbeat, muscle weakness, or numbness in the arms and legs. Kidney damage is usually reversible after stopping aspirin therapy.
REYE’S SYNDROME: Do not administer aspirin to children younger than 18 years of age without checking with their doctor first. Aspirin can cause a rare but serious condition called Reye's syndrome in children, especially when they are recovering from a viral illness such as the flu or chickenpox. Symptoms of Reye's syndrome include headache, nausea, vomiting, confusion, and other behavioral changes.
USE DURING PREGNANCY: Low-dose aspirin (81 mg) is safe to use during pregnancy. However, pregnant women should not take higher doses (325 mg or more) as it can cause harm to an unborn baby by affecting the amount of amniotic fluid, damaging the baby’s kidneys, and causing heart defects. Do not take aspirin after 20 weeks of pregnancy without talking to your doctor first. Tell your doctor if you become pregnant while on aspirin therapy.
ALLERGIC REACTION: Rarely, aspirin can cause a life-threatening skin reaction with signs and symptoms including rash, hives, reddening, and peeling of the skin, and painful fluid-filled blisters. Stop taking aspirin and go to the emergency room if this happens.

Precautions Before Starting Aspirin

Tell your healthcare provider if you have ever had an allergic reaction to aspirin, other nonsteroidal anti-inflammatory drugs, other medications for pain or fever, tartrazine dye, or any other drugs. Your pharmacy can give you a list of active and inactive ingredients in aspirin products.

Give your doctor and pharmacist a full list of your medications, including prescription drugs, over-the-counter medicines, vitamins, supplements, and herbal products. This can help avoid possible drug interactions.

Give your doctor a complete medical history so they can check for contraindications. Aspirin may not be right for people with certain medical conditions such as heartburn, stomach upset, stomach ulcers, bleeding disorders, anemia, kidney disease, liver disease, asthma, frequent stuffy or runny nose, or nasal polyps.

If you are taking acetylsalicylic acid (aspirin) to prevent cardiovascular disease, check with your doctor before taking other NSAIDs like ibuprofen (Motrin, Advil) to treat fever or pain. Your doctor will likely tell you to take other NSAIDs some time away from your daily low-dose aspirin.

Tell all your doctors you are on aspirin before any surgery, including dental procedures.

If you drink three or more alcoholic beverages a day, talk to your doctor about the safety of taking aspirin.

Tell your doctor if you are pregnant, could be pregnant, plan to get pregnant, or are breastfeeding. Low-dose aspirin may be safe to take during pregnancy, but high-dose aspirin (325 mg or more) after 20 weeks of pregnancy can cause harm to an unborn baby.

Precautions During Use of Aspirin

Keep all your healthcare appointments during aspirin therapy. Stop taking aspirin and call your healthcare provider immediately if you notice any signs or symptoms of gastrointestinal bleeding such as bloody or tarry stools, bloody vomit, or vomit that looks like coffee grounds. Call your doctor if you become pregnant while taking aspirin.

Aspirin Drug Interactions

Certain other drugs can affect how aspirin works. Possible interactions between aspirin and other drugs can increase the risk of severe adverse reactions.

The following medications may have interactions with aspirin:

Acetazolamide (Diamox), a medicine used to treat glaucoma and altitude sickness.
Blood pressure medications called angiotensin-converting enzyme (ACE) inhibitors like captopril (Capoten), lisinopril (Prinivil, Zestril), benazepril (Lotensin), fosinopril (Monopril), enalapril (Vasotec), moexipril (Univasc), quinapril (Accupril), perindopril (Aceon), trandolapril (Mavik), and ramipril (Altace).
Beta blockers like labetalol (Normodyne), atenolol (Tenormin), metoprolol (Lopressor, Toprol XL), propranolol (Inderal), and nadolol (Corgard).
Anticoagulants or blood thinner medications like heparin and warfarin (Coumadin).
Diuretics or water pills.
Diabetes medications.
Arthritis medications.
Medications used to treat gout, such as sulfinpyrazone (Anturane) and probenecid.
Other nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn).
Immunosuppressants like methotrexate (Trexall).
Anticonvulsants like valproic acid (Depakote, Depakene) and phenytoin (Dilantin).

The above list may not include all possible interactions of aspirin. Give your doctor or pharmacist a complete list of your medications, including prescription drugs, OTC (non-prescription) medications, dietary supplements, and herbal remedies. Also, tell your healthcare professionals if you smoke, drink alcohol, or use recreational drugs because some of these substances can cause serious health complications when used with medications.

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