The Pharmaceutical Journal
Vol 270 No 7239 p334
8 March 2003

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Letters to the Editor

OTC medicines

A misleading impression of ibuprofen and aspirin use

From Dr D. J. Lott, FFPM

The news item reporting The Lancet publication of the study from MacDonald et al (PJ, 15 February, p217) gives a misleading impression of the conclusions of the paper. I am concerned that this may result in confusion for pharmacists and unnecessary worry for people who are taking low-dose aspirin and occasionally take over-the-counter ibuprofen for relief of headache.

The study reviewed the outcomes in 7,107 patients who had all been admitted to hospital as a result of serious cardiovascular disease. All took daily low-dose aspirin, while a small number (187) also took ibuprofen on prescription. Other groups were prescribed other non-steroidal anti-inflammatory drugs (including diclofenac) as well as the aspirin. All were followed-up for up to eight years and eight months. Mortality rates were calculated for the different groups, and these appeared to show that mortality was increased in the group who took aspirin and ibuprofen. It is important to note that this study evaluated the relationship between low-dose aspirin and ibuprofen taken on prescription for long periods at higher doses than are recommended for OTC use.

The authors point out that the study did not take into account the severity of the cardiovascular disease, doses of the individual NSAIDs, smoking, or body-mass index. The number of patients in the "aspirin and ibuprofen" group was small compared with the "aspirin only" group. Some or all of these factors could have been confounders and skewed the results. The study shows no evidence that occasionally taking ibuprofen, as directed for OTC use has any effect on the cardioprotective effects of aspirin.

It is also important that the study, which concentrated on patients after discharge from hospital, did not look at those who take low-dose aspirin to avoid future heart attacks, and who may occasionally take an OTC pain-killer for a minor condition. They may be reassured that there is no evidence that they would increase their risk by so doing.

David Lott
Chairman,
Medical and Technical Committee,
International Ibuprofen Foundation

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