Combination of low-dose aspirin and NSAIDs
This time, we're going to learn about low-dose aspirin, which is a so-called blood-smoothing medicine.
Have you ever had such a question, everyone?
Why does aspirin alone have an antiplatelet effect among NSIADs?
What will happen to the interaction when other NSAIDs are layered?
What is the effect on the antiplatelet effect of repeated aspirin as an analgesic?
The number one reason we don't use anything other than aspirin
While aspirin is irreversible inhibition, other NSAIDs are reversible inhibition.
Because sustained effects cannot be expected.
Also, in the case of COX-2 selective inhibitors that have a low effect on COX-1, they are not covered in the first place.
So, except for NSIADs with high COX-2 selectivity, it is not without antiplatelet effect, but it is not clinically suitable.
By the way, it is known that celecoxib has almost no effect even when taking aspirin, so it is easy to use together.
In fact, there are many reports that there was no problem even if it was used together.
Although loxoprofen has a low CO X 2 selection system, it is known that it has an influence, although it is limited information because it is not used globally, and it seems that the influence on the dosage interval is also known to some extent.
Because it is necessary to plan the timing of taking it to ensure that it is not affected
Celecoxib looks better.
It seems better not to use ibuprofen together.
By the way, regarding crushing, it would be easier if you could use raw powder.
But there is no thrombus suppression for the indication.
So, enteric tablets may be crushed even in the field, but in general, enteric tablets are often impossible to crush. However, depending on the reason, it is said that it can be crushed.
The reason why aspirin is an enteric tablet is to avoid direct stimulation to the gastric mucosa, and it is said that the effect is not inactivated.
However, regarding this gastric mucosal stimulation, there is also data that it could not be avoided so much even as an enteric tablet (there is also data that it was avoided), so it may not be necessary to stick to enteric tablets so much.The Pharmacist # pharmacy _ pharmacist # pharmacy The nurse There is a pharmacist.
私も薬剤師として日常的に低用量アスピリンを処方する患者さんの管理をしていますが、NSAIDsとの併用は患者の安全や効果を左右する非常に重要なポイントです。 私が特に注意しているのは、アスピリンが不可逆的にCOX-1を阻害することで持続的な抗血小板効果を発揮するのに対し、多くのNSAIDsは可逆的な阻害であるため、同時に服用するとアスピリンの効果が弱まるリスクがある点です。このため、イブプロフェンのようなNSAIDsとは基本的に併用を避け、どうしても必要な場合は服用時間をずらす工夫を行っています。 一方、セレコキシブのようなCOX-2選択性の高いNSAIDsは、COX-1への影響が少なく、アスピリンの抗血小板効果にほとんど影響を与えないため、併用しやすいと実感しています。実際の臨床現場でも、セレコキシブは痛みや炎症の抑制目的で低用量アスピリン服用中の患者に安心して処方できる選択肢として重宝しています。 また、腸溶錠の粉砕については患者さんの飲みやすさのために問い合わせが多いですが、本来は粉砕不可とされている場合が多いものの、使用目的や状況に応じて粉砕が可能となるケースもあるため、患者さん一人ひとりの状況に合わせて判断しています。アスピリンの胃粘膜刺激に関しては、腸溶錠であることの効果が必ずしも大きな違いを生まないという研究もあり、厳格に腸溶錠にこだわる必要もないと感じています。 実務からの視点としては、NSAIDsを使用する際にはまず患者の使用目的と併用薬を把握し、可能な限りアスピリンの効果を妨げないNSAIDsの選択やタイミングの調整を心がけています。今後も新たな報告があれば情報をアップデートしながら、患者の安全と薬効を最大化する工夫を続けていきたいと思います。