4 known interactions • 2 major • 2 moderate • 0 minor
Always disclose all medications to your healthcare providers — prescription medicines, OTC medications, vitamins, and herbal supplements. This list may not include every possible interaction. Use our Medicine Interaction Checker to screen your complete medication list.
Potentially life-threatening or causing permanent damage. Avoid combination.
May worsen condition or require dose adjustment. Monitor closely.
Usually limited clinical effect. Manage with routine monitoring.
Anticoagulants (warfarin, heparins, direct oral anticoagulants)
Aspirin enhances bleeding risk both by antiplatelet effect and by displacing warfarin from protein binding (at high doses). Even low-dose aspirin with warfarin significantly increases major bleeding risk, though this combination is necessary in some cardiac patients.
Management: Use only when benefit clearly outweighs risk (e.g., mechanical valve + aspirin). Maintain close INR monitoring.
Methotrexate
Aspirin displaces methotrexate from protein binding and reduces its renal excretion, increasing methotrexate toxicity.
Management: Avoid combination with high-dose methotrexate. Low-dose methotrexate: monitor carefully.
Ibuprofen / other NSAIDs
Ibuprofen can competitively block aspirin's access to COX-1 platelet binding site (if taken first), reducing aspirin's cardioprotective antiplatelet effect.
Management: Take immediate-release aspirin at least 30 min before ibuprofen to allow aspirin to bind first.
Probenecid / uricosurics
Low-dose aspirin antagonizes the uricosuric effect of probenecid by competing for renal tubular secretion.
Management: Avoid aspirin in patients taking probenecid for gout.
Always ask your pharmacist about potential interactions with food, alcohol, and supplements specific to Aspirin. Some medicines have significant interactions with grapefruit juice, high-fat meals, dairy products, or vitamin K-rich foods.