Worst Pills, Best Pills

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Drug Profile

Do NOT stop taking this or any drug without the advice of your physician. Some drugs can cause severe adverse effects when they are stopped suddenly.

Do Not Use [what does this mean?]
Generic drug name: buffered aspirin (BUH ferd AS pir in)
Brand name(s): ASCRIPTIN, BUFFERIN
GENERIC: not available FAMILIES: Nonsteroidal Anti-inflammatory Drugs (NSAID), Salicylates
Find the drug label by searching at DailyMed.

Do Not Use [what does this mean?]
Generic drug name: diflunisal (dye FLOO ni sal)
Brand name(s): DOLOBID
GENERIC: not available FAMILIES: Nonsteroidal Anti-inflammatory Drugs (NSAID), Salicylates
Find the drug label by searching at DailyMed.

Do Not Use [what does this mean?]
Generic drug name: salsalate (SAL sa late)
Brand name(s): DISALCID
GENERIC: not available FAMILIES: Nonsteroidal Anti-inflammatory Drugs (NSAID), Salicylates
Find the drug label by searching at DailyMed.

Alternative Treatment [top]

See aspirin.

Safety Warnings For This Drug [top]

FDA BLACK-BOX WARNINGS

Cardiovascular Risk

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) may cause an increased risk of serious cardiovascular thrombotic events, including heart attack and stroke, which can be fatal. This risk may occur early in treatment and may increase with duration of use. Patients with cardiovascular disease or risk factors for cardiovascular disease may be at greater risk.
  • NSAIDs are contraindicated for the treatment of peri-operative pain in the setting of coronary artery bypass graft surgery.

Gastrointestinal Risk

  • NSAIDs cause an increased risk of serious gastrointestinal adverse events including bleeding, ulceration and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients are at greater risk of serious gastrointestinal events. (See WARNINGS)

Aspirin/Reye's Syndrome Alert

Do not use this product for treating chicken pox, flu, or flulike illness if you are under 40. It will increase the risk of contracting Reye’s syndrome, a rare but often fatal disease.

Facts About This Drug [top]

Buffered aspirin (ASCRIPTIN, BUFFERIN) is aspirin with a “buffer” or “acid neutralizer” added to it. Advertisements for buffered aspirin claim that it relieves pain faster than plain aspirin because it is absorbed better, and also that it is less irritating to the stomach and intestines than plain aspirin. However, there is no evidence to support these claims.

The amount of buffer in buffered aspirin is very small — only a fraction of the amount found in even one teaspoon of many antacids....

Buffered aspirin (ASCRIPTIN, BUFFERIN) is aspirin with a “buffer” or “acid neutralizer” added to it. Advertisements for buffered aspirin claim that it relieves pain faster than plain aspirin because it is absorbed better, and also that it is less irritating to the stomach and intestines than plain aspirin. However, there is no evidence to support these claims.

The amount of buffer in buffered aspirin is very small — only a fraction of the amount found in even one teaspoon of many antacids. A Food and Drug Administration (FDA) advisory committee found that although buffered aspirin may be absorbed more quickly than plain aspirin, it does not provide much faster pain relief. The committee also found no evidence that buffered aspirin is any gentler to the stomach than plain aspirin.

For patients who take aspirin only occasionally, plain generic aspirin is better than buffered because it is much less expensive and relieves pain just as quickly.

Diflunisal (DOLOBID) and salsalate (DISALCID) should not be used because they have no advantage over plain aspirin. ALKA-SELTZER, a brand of buffered aspirin, should not be taken by anyone whose salt (sodium) intake has been limited.

Adverse effects

Patients who frequently use medication to relieve headache pain may develop a condition known as medication overuse headache (MOH). According to a 2004 review published in Lancet Neurology,[1] there is substantial evidence that all headache drugs can cause MOH in patients who use these drugs excessively.

Aspirin-induced asthma can occur in asthmatic patients who are sensitive to aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs). It typically involves the onset of asthma 30 minutes to three hours after taking aspirin or NSAIDs. Many aspirin- and NSAID-containing products are available without a prescription and many asthmatic patients may be unaware of their sensitivity to aspirin.[2]

Interactions

Studies suggest a possible harmful interaction between NSAIDs and a class of osteoporosis drugs called bisphosphonates. Patients need to be alert to the fact that the combination can result in an increased risk of ulcers and other gastrointestinal adverse effects. Read more in the July 2010 issue of Worst Pills, Best Pills News.

Several studies have shown that combining aspirin or another NSAID with an oral anticoagulant (blood thinners for preventing blood clots) increases the risk of bleeding compared with using an anticoagulant alone.[3],[4]

Studies show...

A recent meta-analysis (a study that combines data from many other studies) compared the risks and benefits of adding aspirin therapy to the drug regimen of patients who were already taking an oral anticoagulant therapy such as warfarin (COUMADIN), including patients with atrial fibrillation or with mechanical heart valves. This study demonstrated that there is little support in the published literature for the common clinical practice of adding aspirin to oral anticoagulant therapy except in select patients with a mechanical heart valve. The additional risk of bleeding was not thought to be warranted.

The Archives of Internal Medicine published a meta-analysis in 2012 in which the authors aimed to assess whether the benefits of aspirin for those without known cardiovascular disease would outweigh aspirin’s increased risk of serious bleeding. The study found that aspirin, taken daily or every other day in low doses for primary prevention of cardiovascular death in patients without existing cardiovascular disease, was not effective in reducing cardiovascular death or death from cancer. Aspirin did, however, increase clinically important bleeding events.[5]

In 2021, Expert Opinion on Pharmacotherapy published an article warning that aspirin was associated with an increased risk of bleeding. The risk of bleeding may outweigh the benefit of preventing heart disease.[6]

Regulatory actions surrounding buffered aspirin

2005: The FDA requested that manufacturers of NSAIDs, both prescription and over-the-counter, revise their labeling to include the potential for the increased risk of cardiovascular events (read the information noted with COX-2 inhibitors) and gastrointestinal bleeding (see above). The FDA also required a Medication Guide to be provided to patients with each prescription dispensed.

2020: The FDA and Health Canada (an agency in Canada similar to the FDA) warned that use of NSAIDs at about 20 weeks or later in pregnancy rarely causes serious kidney problems in an unborn baby.[7],[8] These kidney problems can lead to oligohydramnios, a condition in which there are low levels of amniotic fluid surrounding the baby. Amniotic fluid normally provides a protective cushion and plays an important role in the development of a baby’s lungs, digestive system and muscles. Oligohydramnios in turn can lead to decreased range of motion in a baby’s arms and legs and delayed lung maturation.

last reviewed February 28, 2021