Ibuprofen (Advil®, Motrin®) versus Aspirin

Based on "Essential Pain Pharmacology"
written by Howard S. Smith, MD; Marco Pappagallo, MD

Difference between Ibuprofen and Aspirin

	Ibuprofen	Aspirin (acetylsalicylic acid)
Brand names	Advil®, Motrin®, 1969	Bayer Aspirin®, Bufferin®, Ecotrin®, 1899
Drug class	Non-steroidal anti-inflammatory drugs (NSAIDs)
	Propionic acid derivative	Salicilate
Legal status	Non-controlled substance
	Over-the-counter, Prescription	Over-the-counter
FDA-approved indications	• Fever • Mild to moderate pain • Rheumatoid arthritis • Osteoarthritis • Dysmenorrhea • Headache, migraine
		• As anti-platelet drug to prevent blood clot formation • Prophylaxis of venous thromboembolism
Off-label uses	• Rheumatic fever • Protection against cataract
	• Renal colic • Gingivitis16	• Prevention of niacin induced flushing
Mechanism of action	Inhibits prostaglandin synthesis via non-selective inhibition of COX-1 and 2 COX-2. Ibuprofen is competitive and reversible inhibitor of COX.	Inhibits COX-1 and COX-2 irreversibly by acetylating one of its serine residues. Return of COX activity depends on synthesis of fresh enzyme.
Therapeutic effects	• Analgesic • Antipyretic (anti-fever) • Anti-inflammatory
	• Ibuprofen can inhibit platelet aggregation. However, unlike aspirin, its antithrombotic effect is reversible, weaker, and of shorter duration.	• Antithrombotic - inhibits platelet aggregation
Half-life	2 hours, as the dosage increases, the half-life ranges between 4 and 8 hours	Half-life of aspirin is 15-20 min, half-life of released salicylic acid is 3-5 hours, dose-dependent1.
Oral bioavailability	80-90%	~50% 15
Metabolism, Elimination	• 90% of ibuprofen is metabolized to metabolite A (hydroxyibuprofen) and metabolite B (carboxyibuprofen). • Ibuprofen is almost completely excreted in the urine as unchanged drug and oxidative metabolites.	• Aspirin (acetylsalicylic acid) is rapidly hydrolyzed to salicylic acid. Salicylic acid is conjugated in the liver to the metabolites. • Aspirin elimination is limited by the ability of the liver to conjugate salicylic acid.
Contraindications	• Hypersensitivity to Ibuprofen • Peri-operative pain in the setting of coronary artery bypass graft surgery	• Hypersensitivity to Aspirin, salicylates, NSAIDs • Gastrointestinal ulcers • Hemorrhagic diathesis • Hepatic failure, renal failure, or congestive heart failure
	• Asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs
Warnings & precautions	• Serious gastrointestinal effects: ulceration, bleeding, and perforation • Renal injury
		• Uncontrolled hypertension • Concomitant use of anticoagulants • History of bleeding tendencies
Side effects	• Gastric discomfort, nausea, vomiting, abdominal pain, gastric mucosal damage, peptic ulceration. Ibuprofen has a greater gastrointestinal safety than aspirin5. • Dizziness, tinnitus, headache • Bleedings. Aspirin causes more bleeding than ibuprofen3. • Aspirin is more hepatotoxic than ibuprofen10
	• Ibuprofen is better tolerated and side effects are milder than with aspirin, especially in regard to gastrointestinal complaints2, 11. • Ibuprofen has may increase diastolic blood pressure17.	Aspirin side effects occur more frequently and tend to last longer6. • High doses produce salicylism syndrome, characterized by tinnitus, vertigo, reversible impairment of hearing and vision, excitement and mental confusion, hyperventilation and electrolyte imbalance • Reye's syndrome, a rare form of hepatic encephalopathy
Abuse potential	No
Pregnancy category	C prior to 30 weeks gestation D last trimester of pregnancy	Contraindicated in last trimester of pregnancy

Aspirin is distinguished from NSAIDs in that that it acetylates and inhibits the isozymes permanently. New enzymes must be synthesized to overcome the effects of aspirin. In addition, aspirin interferes with kinin-induced modulation of the inflammatory response.

Comparative Efficacy

Postepisiotomy pain
Ibuprofen 400 mg is more effective than aspirin 600 mg for reducing pain intensity and duration7.

Muscle contraction headaches
Ibuprofen provides better pain relief than aspirin for tension-type headache8.

Dental pain
Analgesic potency of ibuprofen is superior to that of aspirin14.

Fever
Both drugs are comparable in their antipyretic activity9.

Concomitant use of Ibuprofen and Aspirin

Is it safe to take aspirin and ibuprofen at the same time?
Ibuprofen can interact with aspirin effects on platelet aggregation 12, 13 and result in reduced cardioprotective efficacy of aspirin. So patients taking aspirin for blood thinning should either avoid ibuprofen altogether or take it 2 hours after the aspirin.

Further reading

• Non-Steroidal Anti-Inflammatory Drugs Comparison
• Meloxicam vs Ibuprofen
• Naproxen vs Ibuprofen

References

• 1. Needs CJ, Brooks PM. Clinical pharmacokinetics of the salicylates. Clin Pharmacokinet. 1985 Mar-Apr;10(2):164-77. PubMed
• 2. Rampal P, Moore N, Van Ganse E, Le Parc JM, Wall R, Schneid H, Verrière F. Gastrointestinal tolerability of ibuprofen compared with paracetamol and aspirin at over-the-counter doses. J Int Med Res. 2002 May-Jun;30(3):301-8.
• 3. Schmid FR, Culic DD. Antiinflammatory drugs and gastrointestinal bleeding: a comparison of aspirin and ibuprofen. J Clin Pharmacol. 1976 Aug-Sep;16(8-9):418-25. PubMed
• 4. Schmid FR, Culic DD. Antiinflammatory drugs and gastrointestinal bleeding: a comparison of aspirin and ibuprofen. J Clin Pharmacol. 1976 Aug-Sep;16(8-9):418-25. PubMed
• 5. Lanza FL, Royer GL Jr, Nelson RS., et al. The effects of ibuprofen, indomethacin, aspirin, naproxen, and placebo on the gastric mucosa of normal volunteers: a gastroscopic and photographic study. Dig Dis Sci. 1979 Nov;24(11):823-8. PubMed
• 6. Gum OB. Long-term efficacy and safety of benoxaprofen: comparison with aspirin and ibuprofen in patients with active rheumatoid arthritis.J Rheumatol Suppl. 1980;6:76-88. PubMed
• 7. Sunshine A, Olson NZ, Laska EM, et al. Ibuprofen, zomepirac, aspirin, and placebo in the relief of postepisiotomy pain. Clin Pharmacol Ther. 1983 Aug;34(2):254-8. PubMed
• 8. Diamond S. Ibuprofen versus aspirin and placebo in the treatment of muscle contraction headache. Headache. 1983 Sep;23(5):206-10.
• 9. Kandoth PW, Joshi MK, Joshi VR, Satoskar RS. Comparative evaluation of antipyretic activity of ibuprofen and aspirin in children with pyrexia of varied aetiology. J Int Med Res. 1984;12(5):292-7. PubMed
• 10. Freeland GR, Northington RS, Hedrich DA, Walker BR. Hepatic safety of two analgesics used over the counter: ibuprofen and aspirin. Clin Pharmacol Ther. 1988 May;43(5):473-9. PubMed
• 11. Le Parc JM, Van Ganse E, Moore N, Wall R, Schneid H, Verrière F. Comparative tolerability of paracetamol, aspirin and ibuprofen for short-term analgesia in patients with musculoskeletal conditions. Clin Rheumatol. 2002 Feb;21(1):28-31. PubMed
• 12. MacDonald TM, Wei L. Effect of ibuprofen on cardioprotective effect of aspirin. Lancet. 2003;361:573-574.
• 13. Gengo FM, et al. Effects of ibuprofen on the magnitude and duration of aspirin’s inhibition of platelet aggregation: clinical consequences in stroke prophylaxis. J Clin Pharmacol. 2008;48:117-122. PubMed
• 14. Cooper SA, Needle SE, Kruger GO. Comparative analgesic potency of aspirin and ibuprofen. J Oral Surg. 1977 Nov;35(11):898-903. PubMed
• 15. Pedersen AK, FitzGerald GA. Dose-related kinetics of aspirin. Presystemic acetylation of platelet cyclooxygenase. N Engl J Med. 1984 Nov 8;311(19):1206-11. PubMed
• 16. Taiyeb Ali TB, Waite IM. The effect of systemic ibuprofen on gingival inflammation in humans. J Clin Periodontol. 1993 Nov;20(10):723-8.
• 17. Klassen D, Goodfriend TL, Schuna AA, Young DY, Peterson CA. Assessment of blood pressure during treatment with naproxen or ibuprofen in hypertensive patients treated with hydrochlorothiazide. J Clin Pharmacol. 1993 Oct;33(10):971-8.

Published: December 20, 2016
Last updated: December 05, 2017