OTC Aspirin: Which Strength Should You Choose? A Pharmacist Explains

By Samer Altameemi - Rph (See affiliate disclosure below)

Aspirin has been used for more than 100 years and remains one of the most recognized over-the-counter medications. While many people keep it at home for pain relief, OTC aspirin isn't the right choice for everyone.

As a pharmacist, one of the biggest misconceptions I hear is that aspirin is "just another pain reliever." In reality, aspirin has unique benefits—and unique risks—that make it different from ibuprofen, naproxen, and acetaminophen.

One thing many people don't realize is that OTC aspirin comes in two common strengths, and each has a different purpose.

Low-Dose Aspirin (81 mg)

81 mg aspirin, often called baby aspirin or low-dose aspirin, is primarily used to help prevent blood clots. It may be recommended by a healthcare provider for people who have:

• Had a heart attack.

• Had an ischemic stroke or transient ischemic attack (TIA).

• Coronary artery disease or coronary stents.

• Other cardiovascular conditions where preventing blood clots is important.

Although 81 mg aspirin can relieve pain, it's generally not used for routine pain relief because the dose is too low for most adults.

Can I Take an 81 mg Aspirin Every Day?

For many years, people were encouraged to take a daily aspirin to prevent a first heart attack.

Today, recommendations have changed. For many healthy adults without a history of heart attack or stroke, the risk of bleeding may outweigh the benefit. Don't start taking a daily aspirin unless your healthcare provider recommends it.

Regular-Strength Aspirin (325 mg)

325 mg aspirin is used for temporary relief of:

• Headaches

• Muscle aches

• Tooth pain

• Minor arthritis pain

• Fever

Because aspirin is an NSAID (nonsteroidal anti-inflammatory drug), it helps reduce both pain and inflammation.

While it can be effective, it's usually not my first choice for routine pain relief because it has a higher risk of stomach irritation and bleeding than many other OTC pain relievers.

If Aspirin Isn't My First Choice for Pain, What Should You Use Instead?

For most everyday aches and pains, I usually recommend choosing an OTC pain reliever based on your symptoms rather than automatically reaching for aspirin.

Some common alternatives include:

• Tylenol® (acetaminophen)

• Advil® or Motrin® (ibuprofen)

• Aleve® (naproxen)

• Voltaren Arthritis Pain Gel®

• Biofreeze®

• Aspercreme® Lidocaine

The best choice depends on your symptoms, medical conditions, and the other medications you take.

To find the most approprite product for you, visit our Headache page , or Muscle & Joint Pain page.

Who Should Avoid Aspirin?

Aspirin may not be the best choice if you:

• Have a history of stomach ulcers or gastrointestinal bleeding.

• Take a blood thinner.

• Have aspirin-sensitive asthma.

• Have severe kidney disease.

• Are younger than 19 years old and recovering from a viral illness because of the risk of Reye's syndrome.

Common Drug Interactions

One of the most important counseling points about aspirin is that it interacts with several commonly used medications.

Blood Thinners

Taking aspirin with blood thinners such as warfarin (Coumadin®), apixaban (Eliquis®), rivaroxaban (Xarelto®), or dabigatran (Pradaxa®) can significantly increase the risk of bleeding.

Other NSAIDs

Avoid routinely combining aspirin with:

• Advil® or Motrin® (ibuprofen)

• Aleve® (naproxen)

Taking these medications together increases the risk of stomach ulcers, bleeding, and kidney problems.

Steroids

Steroids such as prednisone and methylprednisolone can further increase the risk of stomach irritation and bleeding.

Alcohol

Regular alcohol use while taking aspirin also increases the risk of stomach bleeding.

Can Aspirin Interact with Ibuprofen?

Yes.

If you're taking 81 mg aspirin for heart protection, ibuprofen may reduce aspirin's ability to prevent blood clots if they're taken too close together.

If you've been prescribed daily aspirin, ask your pharmacist about the best timing before taking ibuprofen.

Don't Forget About Excedrin®

Many people don't realize that Excedrin® already contains 325 mg of aspirin.

Taking Excedrin® with aspirin tablets can accidentally increase your aspirin dose and raise your risk of bleeding.

Always read the Drug Facts label before combining OTC medications.

A Pharmacist's Tip

The biggest mistake I see isn't choosing the wrong strength—it's choosing the wrong medication.

Many people automatically reach for aspirin because it's familiar, but it isn't always the best choice. Match the medication to your symptoms, consider your medical conditions and other medications, and reserve daily low-dose aspirin for situations where it's recommended by your healthcare provider.

Found OTC  is your place to find smart over-the-counter solutions for common daily conditions, designed by the pharmacist.

Pharmacist Reviewed: the information in this article was clinically reviewed by Samer Altameemi, a licensed pharmacist. It is intended for educational purposes, not to substitute for a doctor's professional medical advice.

Disclosure: some links in the above article are affiliate links where we might earn a small commission at no extra cost to you.