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Drug Information

Common brand names:


Summary of Interactions with Vitamins, Herbs, & Foods

Types of interactions: Beneficial Adverse Check

Replenish Depleted Nutrients

  • Iron

    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 tests.

  • Vitamin C

    Taking aspirin has been associated with increased loss of vitamin C in urine and has been linked to depletion of vitamin C. 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.

  • Zinc

    Intake of 3 grams of aspirin per day has been shown to decrease blood levels of zinc. Aspirin appeared to increase loss of zinc in the urine in this study, and the effect was noted beginning three days after starting aspirin.

  • Folic Acid

    Increased loss of folic acid in urine has been reported in rheumatoid arthritis patients. Reduced blood levels of the vitamin have also been reported in people with arthritis who take aspirin. 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.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Vitamin B12

    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. 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 factor).

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Reduce Side Effects

  • Probiotics
    In one study, treatment with a probiotic preparation promoted healing of small-intestinal damage that was apparently caused by taking aspirin. The probiotic strain used in the study was Lactobacillus casei, and was taken daily for 3 months.

Support Medicine

  • Chili Peppers

    Cayenne (Capsicum annuum, Capsicum frutescens) 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. 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. However, cayenne may cause stomach irritation in some individuals with stomach inflammation (gastritis) or ulcers and should be used with caution.

  • Licorice

    The flavonoids found in the extract of licorice (Glycyrrhiza glabra) 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. DGL has been shown in controlled human research to be as effective as drug therapy (cimetidine) in healing stomach ulcers. 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.

  • Garlic

    A test tube study has shown ajoene, a compound found in garlic that prevents platelet clumping, enhances the beneficial action of dipyridamole on human platelets. Controlled research is needed to determine whether taking garlic supplements together with dipyridamole might enhance the effectiveness of either compound taken alone.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Reduces Effectiveness

  • none

Potential Negative Interaction

  • Dan shen (Salvia miltiorrhiza), a Chinese herb, was associated with increased warfarin activity in two cases. Although warfarin acts differently from ticlopidine, both affect parameters of bleeding. Until more is known, people taking ticlopidine should use dan shen only under close medical supervision. Sage (Salvia officinalis), a plant relative of dan shen found in the West, has not been not associated with interactions involving warfarin.

  • Eleuthero

    Ginseng (Panax ginseng) was associated with a decrease in warfarin activity in a case study. This report suggests that ginseng may affect parameters of bleeding. Therefore, people taking ticlopidine should consult with a physician knowledgeable about botanical medicines before taking Asian ginseng or eleuthero/Siberian ginseng (Eleutherococcus senticosus).

  • Ginkgo

    There have been two case reports suggesting a possible interaction between ginkgo Ginkgo biloba and an anticoagulant drug or aspirin leading to increased bleeding. 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.

  • Reishi

    As it may increase bleeding time, reishi (Ganoderma lucidum) is not recommended for those taking anticoagulant (blood-thinning) medications.

  • Vitamin E

    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. 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). The authors concluded that vitamin E might, especially if combined with aspirin, increase the risk of bleedings.

  • Coleus

    There are theoretical grounds to believe that coleus  (Coleus forskohlii) 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.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Taking dipyridamole can cause a reduction in the amount of oxygen delivered to the heart, resulting in a rare side effect known as angina pectoris. Because dipyridamole has this effect, it has sometimes been used in heart stress tests. One person who consumed coffee prior to the test failed to experience the expected reduction in blood flow caused by dipyridamole. Controlled studies are needed to determine whether consumption of beverages containing caffeine might reduce the likelihood of developing angina from the drug.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Explanation Required 

  • Bromelain

    In theory, bromelain might enhance the action of anticoagulants. This theoretical concern has not been substantiated by human research, however.

  • Ginger

    Ginger has been shown to reduce platelet stickiness in test tubes. Although there appear to be no reports of interactions with platelet inhibiting drugs, people should talk with a healthcare professional if they are taking a platelet inhibitor and wish to use ginger.

The Drug-Nutrient Interactions table may not include every possible interaction. Taking medicines with meals, on an empty stomach, or with alcohol may influence their effects. For details, refer to the manufacturers’ package information as these are not covered in this table. If you take medications, always discuss the potential risks and benefits of adding a new supplement with your doctor or pharmacist.

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