Ibuprofen (Advil®, Motrin®) versus Aspirin
Based on "Essential Pain Pharmacology"
written by Howard S. Smith, MD; Marco Pappagallo, MD
Difference between Ibuprofen and Aspirin
|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|
|FDA-approved indications||• Fever
• Mild to moderate pain
• Rheumatoid arthritis
• 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
|• 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)
|• 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
|• 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
|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.
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.
Analgesic potency of ibuprofen is superior to that of aspirin14.
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.
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- 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
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- 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
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- 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