Moderate
Acetylsalicylic acid × naproxen
Antiplatelet agents (low dose) / NSAIDs (analgesic dose)×NSAID, propionic acid derivative
Mechanism
Naproxen (NSAID) may block aspirin's acetylation of platelet cyclooxygenase-1, reducing its cardioprotective effect. Plus additive GI bleeding risk from two antiplatelet and ulcerogenic drugs.
Symptoms
Gum bleeding, epistaxis, bruising without trauma, black or tarry stools. Severe cases: GI bleeding.
Management
If the patient takes aspirin for cardioprotection, give aspirin 30 minutes before or 8 hours after naproxen. Alternative analgesic without this issue: paracetamol or a selective COX-2 inhibitor (celecoxib).