Also indexed as: Acetylsalicylic Acid, ASA
Aspirin is a drug that reduces swelling,
pain, and fever. In recent years, long-term low-dose aspirin has been recommended to
reduce the risk of heart attacks and strokes. In the future aspirin may be recommended to
reduce the risk of some cancers. Reye’s
syndrome, a rare but serious illness affecting children and teenagers, has been associated
with aspirin use. To prevent Reye’s syndrome, people should consult their doctor and/or
pharmacist before giving aspirin, aspirin-containing products, or herbs containing salicylates
to children and teenagers.
Interactions with Vitamins, Herbs, and Foods
In some cases, an herb or supplement may appear in more than one category, which may seem
contradictory. For clarification, read the full article for details about the summarized
| May Be Beneficial: Depletion or
interference—The medication may deplete or interfere with the absorption or
function of the nutrient. Taking these nutrients may help replenish them.
| May Be Beneficial: Supportive
interaction—Taking these supplements may support or otherwise help your medication
Avoid: Adverse interaction—Avoid these supplements when taking this
medication because taking them together may cause undesirable or dangerous results.
|Side effect reduction/prevention
An asterisk (*) next to an item in the summary indicates that the
interaction is supported only by weak, fragmentary, and/or contradictory scientific
Interactions with Dietary Supplements
Increased loss of folic acid in urine has been reported in rheumatoid arthritis patients.1 Reduced
blood levels of the vitamin have also been reported in people with arthritis who take
aspirin.2 Some doctors recommend for people with arthritis who regularly take
aspirin to supplement 400 mcg of folic acid per day—an amount frequently found in multivitamins.
Gastrointestinal (GI) bleeding is a common side effect of taking aspirin. A person with
aspirin-induced GI bleeding may not always have symptoms (like stomach pain) or obvious signs
of blood in their stool. Such bleeding causes loss of iron from the body. Long-term blood loss
due to regular use of aspirin can lead to
iron-deficiency anemia. Lost iron can be replaced with iron supplements. Iron
supplementation should be used only in cases of iron deficiency verified with laboratory
In a study of people hospitalized with heart disease, those who had been taking aspirin were
nearly twice as likely as nonusers to have a low or marginally low blood level of vitamin
B12.3 That finding by itself does not prove that taking aspirin causes vitamin B12
deficiency. However, aspirin is known to damage the stomach in some cases, and the stomach
plays a key role in vitamin B12 absorption (by secreting hydrochloric acid and intrinsic
Taking aspirin has been associated with increased loss of vitamin C in urine and has been
linked to depletion of vitamin C.4 People who take aspirin regularly should
consider supplementing at least a few hundred milligrams of vitamin C per day. Such an amount
is often found in a multivitamin.
Although vitamin E is thought to act like a blood thinner, very little research has supported
this idea. In fact, a double-blind trial found that very high amounts of vitamin E do not
increase the effects of the powerful blood-thinning drug warfarin.5 Nonetheless, a double-blind
study of smokers found the combination of aspirin plus 50 IU per day of vitamin E led to a
statistically significant increase in bleeding gums compared with taking aspirin alone
(affecting one person in three versus one in four with just aspirin).6 The authors
concluded that vitamin E might, especially if combined with aspirin, increase the risk of
Intake of 3 grams of aspirin per day has been shown to decrease blood levels of
zinc.7 Aspirin appeared to increase loss of zinc in the urine in this study, and
the effect was noted beginning three days after starting aspirin.
Interactions with Herbs
(Capsicum annuum, Capsicum frutescens)
Cayenne contains the potent chemical capsaicin, which acts on special nerves found in the
stomach lining. In two rat studies, researchers reported that stimulation of these nerves by
capsaicin might protect against the damage aspirin can cause to the stomach.8
9 In a study of 18 healthy human volunteers, a single dose of 600 mg aspirin taken after
ingestion of 20 grams of chili pepper was found to cause less damage to the lining of the
stomach and duodenum (part of the small intestine) than aspirin without chili
pepper.10 However, cayenne may cause stomach irritation in some individuals with
stomach inflammation (gastritis) or ulcers and should be used with caution.
There are theoretical grounds to believe that coleus could increase the effect of
anti-platelet medicines such as aspirin, possibly leading to spontaneous bleeding. However,
this has never been documented to occur. Controlled human research is needed to determine
whether people taking aspirin should avoid coleus.
There have been two case reports suggesting a possible interaction between ginkgo and an
anticoagulant drug or aspirin leading to increased bleeding.11 12 In the
first, a 78-year-old woman taking warfarin
developed bleeding within the brain following the concomitant use of ginkgo (the amount used
is not given in the case report). In the second, a 70-year-old man developed slow bleeding
behind the iris of the eye (spontaneous hyphema) following use of ginkgo (80 mg per day)
together with aspirin (325 mg per day). While this interaction is unproven, anyone taking
anticoagulant medications or aspirin should inform their physician before using ginkgo.
The flavonoids found in the extract of licorice known as DGL (deglycyrrhizinated licorice) are
helpful for avoiding the irritating actions aspirin has on the stomach and intestines. One
study found that 350 mg of chewable DGL taken together with each dose of aspirin reduced
gastrointestinal bleeding caused by the aspirin.13 DGL has been shown in controlled
human research to be as effective as drug therapy (cimetidine) in healing stomach ulcers.14 One animal study also showed that
DGL and the acid-blocking drug Tagamet® (cimetidine) work together more effectively than
either alone for preventing negative actions of aspirin.15
1. Buist RA. Drug-nutrient interactions—an overview. Intl Clin
Nutr Rev 1984;4(3):114 [review].
2. Alter HJ, Zvaifler MJ, Rath CE. Interrelationship of rheumatoid
arthritis, folic acid and aspirin. Blood 1971;38:405–16.
3. Van Oijen MGH, Laheij RJF, Peters WHM, et al. Association of aspirin
use with vitamin B12 deficiency (results of the BACH study). Am J Cardiol
4. Coffey G, Wilson CWM. Ascorbic acid deficiency and aspirin-induced
haematemesis. BMJ 1975;I:208.
5. Kim JM, White RH. Effect of vitamin E on the anticoagulant response to
warfarin. Am J Cardiol 1996;77:545–6.
6. Liede KE, Haukka JK, Saxén LM, Heinon OP. Increased tendency
towards gingival bleeding caused by joint effect of alpha-tocopherol supplementation and
acetylsalicylic acid. Ann Med 1998;30:542–6.
7. Ambanelli U, Ferraccioli GF, Serventi G, Vaona GL. Changes in serum
and urinary zinc induced by ASA and indomethacin. Scand J Rheumatol
8. Abdel Salam OME, Mószik G, Szolcsányi J. Studies on the
effect of intragastric capsaicin on gastric ulcer and on the prostacyclin-induced
cytoprotection in rats. Pharmacol Res 1995;32:209–15.
9. Holzer P, Pabst MA, Lippe IT. Intragastric capsaicin protects against
aspirin-induced lesion formation and bleeding in the rat gastric mucosa.
10. Yeoh KG, Kang JY, Yap I, et al. Chili protects against
aspirin-induced gastroduodenal mucosal injury in humans. Dig Dis Sci
11. Matthews MK. Association of Ginkgo biloba with intracerebral
hemorrhage [letter]. Neurology 1998;50:1933.
12. Rosenblatt M, Mindell J. Spontaneous hyphema associated with
ingestion of Ginkgo biloba extract [letter]. N Engl J Med 1997;336:1108.
13. Rees WDW, Rhodes J, Wright JE, et al. Effect of deglycyrrhizinated
liquorice on gastric mucosal damage by aspirin. Scand J Gastroenterol
14. Morgan AG, McAdam WAF, Pascoo C, Darnborough A. Comparison between
cimetidine and Caved-S in the treatment of gastric ulceration, and subsequent maintenance
therapy. Gut 1982;23:545–51.
15. Bennett A, Clark-Wibberley T, et al. Aspirin-induced gastric mucosal
damage in rats: Cimetidine and deglycyrrhizinated liquorice together give greater protection
than low doses of either drug alone. J Pharm Pharmacol 1980;32:151.