Aspirin - low dose - EM Doctors

1. About low-dose aspirin

Daily low-dose aspirin is a blood thinning medicine. Aspirin is also known as acetylsalicylic acid.

Low-dose aspirin helps to prevent heart attacks and strokes in people at high risk of them.

Your doctor may suggest that you take a daily low dose if you have had a stroke or a heart attack to help stop you having another one.

Or, if you're at high risk of heart attack - for example, if you have had heart surgery or if you have chest pain caused by heart disease (angina).

Only take daily low-dose aspirin if your doctor recommends it.

Low-dose aspirin comes as tablets. It's available on prescription. You can also buy it from pharmacies, shops and supermarkets.

Children are sometimes treated with low-dose aspirin after heart surgery or to treat a rare illness called Kawasaki disease. Children should only take low-dose aspirin if their doctor prescribes it.

Taking low-dose aspirin to prevent heart attacks and strokes is not the same as taking aspirin as a painkiller. Read our information on aspirin for pain relief.

NHS coronavirus advice

There is currently no strong evidence that non-steroidal anti-inflammatories (NSAIDs) such as ibuprofen or high-dose aspirin can make coronavirus (COVID-19) worse.

But until we have more information, take paracetamol to treat the symptoms of coronavirus, unless your doctor has told you paracetamol is not suitable for you.

Low-dose aspirin does not act as an NSAID. You can continue to take this medicine as usual, whether you have symptoms of coronavirus or not.

Updated: 20 March 2020

2. Key facts

Daily low-dose aspirin makes the blood less sticky and helps to prevent heart attacks and stroke.
It's usual to take a dose of 75mg once a day. Sometimes doses may be higher.
It's best to take low-dose aspirin with food so it doesn't upset your stomach.
Taking low-dose aspirin isn't safe for everyone. Only take low-dose aspirin if your doctor recommends it.
Low-dose aspirin is also called by the brand names Caprin, Danamep, Micropirin and Nu-seals.

3. Who can and can't take low-dose aspirin

Most people aged 16 or over can safely take low-dose aspirin if their doctor recommends it.

Low-dose aspirin isn't suitable for certain people.

It's sometimes called baby aspirin because of the small dose, but it's not safe for children.

Never give aspirin to a child younger than 16, unless their doctor prescribes it.

There's a possible link between aspirin and Reye's syndrome in children.

Reye's syndrome is a very rare illness that can cause serious liver and brain damage.

Important

Never give aspirin to children younger than 16, unless their doctor prescribes it.

To make sure low-dose aspirin is safe for you, tell your doctor if you have:

an allergy to aspirin or similar painkillers such as ibuprofen
ever had a stomach ulcer
high blood pressure
indigestion
heavy periods - taking daily aspirin can make them heavier
recently had a stroke (low-dose aspirin isn't suitable for some types of stroke)
asthma or lung disease
ever had a blood clotting problem
liver or kidney problems
gout - it can get worse if you take daily aspirin

Check with your doctor that it's safe for you to take low-dose aspirin if you're pregnant, trying to get pregnant, or if you want to breastfeed.

4. How and when to take it

Take low-dose aspirin once a day. Don't take it on an empty stomach. It's best to take it with or just after food. This will make it less likely to upset your stomach.

How much should I take?

Your doctor will discuss what dose is right for you. It's important to take low-dose aspirin exactly as recommended by your doctor.

The usual dose to prevent a heart attack or stroke is 75mg once a day (a regular strength tablet for pain relief is 300mg).

The daily dose may be higher - up to 300mg once a day - especially if you have just had a stroke, heart attack or heart bypass surgery.

Different types of low-dose aspirin tablets

Low-dose aspirin comes as several different types of tablet:

standard tablets - that you swallow whole with water
soluble tablets - that you dissolve in a glass of water
enteric coated tablets - that you swallow whole with water. These tablets have a special coating that means they may be gentler on your stomach. Do not chew or crush them because it'll stop the coating working. If you also take indigestion remedies, take them at least 2 hours before or after you take your aspirin. The antacid in the indigestion remedy affects the way the coating on these tablets works.

You can buy low-dose enteric coated aspirin and low-dose soluble aspirin from pharmacies, shops and supermarkets.

What if I forget to take it?

If you forget to take a dose of aspirin, take it as soon as you remember. If you don't remember until the following day, skip the missed dose.

Do not take a double dose to make up for a forgotten dose.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to remember to take your medicine.

What if I take too much?

Taking 1 or 2 extra tablets by accident is unlikely to be harmful.

The amount of aspirin that can lead to overdose varies from person to person.

Urgent advice: Call your doctor straight away if:

You take too much aspirin by accident and experience side effects such as:

feeling sick (nausea)
ringing in the ears (tinnitus)
hearing problems
confusion
dizziness

If you need to go to a hospital accident and emergency (A&E) department, do not drive yourself - get someone else to drive you or call for an ambulance.

Take the aspirin packet or leaflet inside it, plus any remaining medicine, with you.

5. Side effects

Like all medicines, aspirin can cause side effects, although not everyone gets them.

Common side effects

Common side effects of aspirin happen in more than 1 in 100 people.

Talk to your doctor or pharmacist if the side effects bother you or don't go away:

mild indigestion
bleeding more easily than normal - because aspirin thins your blood, it can sometimes make you bleed more easily. For example, you may get nosebleeds and bruise more easily, and if you cut yourself, the bleeding may take longer than normal to stop.

Serious side effects

It happens rarely, but some people have serious side effects after taking low-dose aspirin.

Call a doctor straight away if you get:

red, blistered and peeling skin
coughing up blood or blood in your pee, poo or vomit
yellow skin or the whites of your eyes turn yellow - this can be a sign of liver problems
painful joints in the hands and feet - this can be a sign of high levels of uric acid in the blood
swollen hands or feet - this can be a sign of water retention

Serious allergic reaction

In rare cases, it's possible to have a serious allergic reaction to aspirin.

Immediate action required: Call 999 or go to A&E if:

you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
you're wheezing
you get tightness in the chest or throat
you have trouble breathing or talking
your mouth, face, lips, tongue or throat start swelling

You could be having a serious allergic reaction and may need immediate treatment in hospital.

These aren't all the side effects of aspirin.

For a full list, see the leaflet inside your medicines packet.

You can report any suspected side effect to the UK safety scheme.

6. How to cope with side effects

What to do about:

mild indigestion - take your aspirin with food. If the indigestion still doesn't go away, it could be a sign that the aspirin has caused a stomach ulcer. Talk to your doctor - they may prescribe something to protect your stomach or switch you to a different medicine.
bleeding more easily than normal - be careful when doing activities that might cause an injury or a cut. Always wear a helmet when cycling. Wear gloves when you use sharp objects like scissors, knives, and gardening tools. Use an electric razor instead of wet shaving, and use a soft toothbrush and waxed dental floss to clean your teeth. See a doctor if you're worried about any bleeding.

7. Pregnancy and breastfeeding

Pregnancy and low-dose aspirin

It's generally safe to take low-dose aspirin during pregnancy, as long as your doctor has said it's OK.

Your doctor may advise you to take low-dose aspirin during pregnancy:

to help prevent heart attack and stroke
to help prevent pre-eclampsia (pregnancy-related high blood pressure)
if you're having fertility treatment
if you have had several previous miscarriages

For more information about how low-dose aspirin can affect you and your baby during pregnancy, read this leaflet on the Best Use of Medicines in Pregnancy (BUMPS) website.

Breastfeeding and low-dose aspirin

Aspirin is not generally recommended while you're breastfeeding.

But your doctor may suggest that you take low-dose aspirin while you're breastfeeding if they think the benefits of the medicine outweigh the possible harm.

Non-urgent advice: Tell your doctor if you're:

trying to get pregnant
pregnant
breastfeeding

8. Cautions with other medicines

Some medicines interfere with the way aspirin works.

Tell your doctor if you're taking these medicines before you start taking aspirin:

medicines to thin blood or prevent blood clots, such as clopidogrel and warfarin - taking them with aspirin might cause bleeding problems
medicines for pain and inflammation, such as ibuprofen and prednisolone
medicines to prevent organ rejection after a transplant, such as ciclosporin and tacrolimus
medicines to treat high blood pressure, such as furosemide and ramipril
digoxin, a medicine for heart problems
lithium, a medicine for mental health problems
acetazolamide, for an eye problem called glaucoma
methotrexate, a medicine used to stop the immune system overreacting and sometimes to treat some types of cancer
diabetes medicines, such as insulin and gliclazide

Mixing low-dose aspirin with painkillers

It's safe to take paracetamol with low-dose aspirin.

But don't take ibuprofen at the same time as low-dose aspirin without talking to your doctor.

Aspirin and ibuprofen both belong to the same group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs).

If you take them together, it can increase your chances of side effects like stomach irritation.

Mixing low-dose aspirin with herbal remedies or supplements

Aspirin may not mix well with quite a lot of complementary and herbal medicines. Aspirin could change the way they work and increase your chances of side effects.

For safety, speak to your pharmacist or doctor before taking any herbal or alternative remedies with aspirin.

Important

Tell your doctor or pharmacist if you are taking any other medicines, including herbal medicines, vitamins or supplements.

9. Common questions

How does low-dose aspirin work?

Aspirin slows the blood's clotting action by making platelets less sticky.

Platelets are blood cells that stick together and block cuts and breaks in blood vessels, so they're important in normal health.

But in people at risk of heart attacks and stroke, platelets can stick together inside already narrowed blood vessels to form a clot.

The clot can stop blood flowing to the heart or brain and cause a heart attack or stroke.

If you take it every day, low-dose aspirin stops platelets clumping together to form unwanted blood clots - and prevents heart attacks and stroke.

When will I feel better?

How long will I take it for?

Is it safe to take for a long time?

Can I drink alcohol with it?

Does low-dose aspirin cause stomach ulcers?

Can I take painkillers with low-dose aspirin?

Is there any food or drink I need to avoid?

Will it affect my fertility?

Will it affect my contraception?

Are there alternatives to low-dose aspirin?

Should we all take low-dose aspirin to prevent heart attacks and strokes?

No, this isn't recommended.

If you have had a heart attack or stroke, or you're at high risk of either, studies have shown that the benefits of taking daily low-dose aspirin far outweigh the risk of side effects.

But if you don't have heart disease and aren't considered to be at high risk of developing it, the risk of side effects (particularly the risk of bleeding) outweighs the benefit of preventing blood clots.

Can lifestyle changes help?

If you have been advised by a doctor to take daily low-dose aspirin, you can also boost your health by making some key lifestyle changes.

Quit smoking - smoking increases your heart rate and blood pressure and increases your risk of heart attack and stroke. Try to avoid secondhand smoke, too.
Cut down on alcohol - try to keep to the recommended guidelines of no more than 14 units of alcohol a week. A standard glass of wine (175ml) is 2 units. A pint of lager or beer is usually 2 to 3 units of alcohol.
Exercise - regular exercise keeps your heart and blood vessels in good condition. It doesn't need to be too energetic - walking every day is enough.
Eat well - aim to eat a diet that includes plenty of fruit and veg, wholegrains, fat-free or low-fat dairy products and lean proteins. It's a good idea to cut down on salt, too. Aim for no more than 6g of salt a day.
Deal with stress - when you're anxious or upset, your heart beats faster, you breathe more heavily, and your blood pressure often goes up. This raises your risk of heart attack and stroke. Find ways to reduce stress in your life. To give your heart a rest, try napping or putting your feet up when possible. Spend time with friends and family to be social and help keep stress at bay.
Vaccinations - if you have heart disease, it's recommended that you have a flu jab every year and a pneumonia vaccination (also called the pneumococcal vaccine) every 5 years. Ask your doctor about these vaccinations. You can have them free on the NHS.