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How Safe is Aspirin in Older Adults?

Aspirin and children

Just because aspirin has been used for more than 100 years and is available over the counter doesn’t mean it is always safe. Aspirin can be an especially dangerous drug among older adults, who are often also taking multiple prescription medications.

An April 2009 study of 1,062 older adults (average age, 70 years) found that those who took aspirin or similar blood-thinning drugs experienced minute bleeding in the brain, while patients who did not take these anti-clotting drugs were much less likely to have the microbleeds. The study also found that the microbleeds were especially pronounced among people who took higher doses of aspirin.

This finding is significant because while the benefits of anti-clotting drugs for older adults at risk for heart attack and stroke may outweigh the risks of bleeding for many people, for others it may not. Doctors therefore need to evaluate aspirin use for each older patient individually.

Older adults are more likely than younger people to have conditions that counterindicate the use of aspirin. Individuals who have any of the following conditions should consult their physician before using aspirin:

Bleeding of the stomach or intestinal tract

Bleeding disorder

Allergy to nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin), naproxen (Aleve), piroxicame (Feldene), nabumetone (Relafen), and etodolac (Lodine)

Asthma or seasonal allergies

Stomach ulcers

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Kidney or liver disease

High blood pressure

Heart disease

Congestive heart failure


Nasal polyps

The concomitant use of aspirin and certain drugs may cause bruising or a tendency to bleed easily. Some of those drugs include antidepressants such as citalopram (Celexa), duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft), or venlafaxine (Effexor); blood thinners such as warfarin; and other salicylates such as choline salicylate, magnesium salicylate, or salsalate.

A safe way for older adults to use aspirin is to take it with a full glass of water. To avoid stomach upset, aspirin can be taken with food or milk. Many doctors recommend taking enteric-coated aspirin, which is designed to be gentle on the stomach, but it should be taken with food or milk as well. Extended-release aspirin is also available.

Enteric-coated aspirin and extended release aspirin should be swallowed whole and never chewed, crushed, or broken. Individuals who cannot swallow a solid form of aspirin should ask a pharmacist to prepare a liquid or powder form.

Symptoms of aspirin overdose include those that older adults may associate with other conditions: headache, ringing in the ears, nausea, vomiting, dizziness, confusion, rapid breathing, fever, seizure, or hallucinations. Anyone who experiences these symptoms should seek medical assistance. Because aspirin is an ingredient in many other over-the-counter medications, everyone should read labels carefully to ensure they are not taking too much aspirin in a combination of products.

US Preventive Services Task Force, Annals of Internal Medicine, 2009 Mar 27; 159(6): 396-404
Vernooji MW et al. Archives of Neurology 2009 Apr 13