What happens if you take Tylenol and aspirin together?

Like many people, I take low-dose aspirin (one baby aspirin a day) for a heart condition. Does taking aspirin mean I can't take ibuprofen or some of the other pain relievers on the market? Package inserts warn against using both at the same time. What should I use for ordinary pain relief, such as an occasional headache or muscle pain? A. The package insert appropriately tells you not to take two types of pain relievers without consulting your doctor. I'll give you some general guidelines on the pros and cons of mixing these over-the-counter medications.

The reason for the warning is that taking both aspirin and ibuprofen can increase your chance of side effects, from an upset stomach to mild bleeding to ulcers. However, in small doses and for short periods (a few days or so) the combination would most likely be safe. But in most cases, there's no reason to take them together.

Aspirin and ibuprofen belong to a class of drugs known as NSAIDs, non-steroidal anti-inflammatory drugs. These drugs block a substance called prostaglandin, which plays a role in many body functions, including inflammation and the pain associated with it. There are more than a dozen NSAIDs available, making this class one of the most widely prescribed and used types of medicine. And now there are several available without a prescription, with more on the way. Besides aspirin, the granddaddy of all NSAIDs, you can choose from ibuprofen (Advil, Motrin and Nuprin), naproxen (Aleve) and ketoprofen (Actron and Orudis).

If you're on a low-dose aspirin anyway and need a pain reliever for a headache, you could simply substitute a standard dose of aspirin for the baby aspirin, as long as your doctor approves. Another option is to take acetaminophen (Tylenol and other brands), which isn't an NSAID.

Acetaminophen came under some criticism recently because of a lawsuit involving a man who developed liver failure when he mixed it with regular use of alcohol. Because of this incident, you'll start seeing warning labels about the small potential risk of combining alcohol with pain relievers, both acetaminophen as well as NSAIDs.

Despite this rare but serious side effect, acetaminophen remains a safe drug for most people. NSAIDs are safe enough to win FDA approval for over-the-counter use. But heavy regular use carries the potential for serious side effects, in particular intestinal bleeding.

My advice? To relieve pain or fever, my first choice is usually acetaminophen. Even the pain of mild arthritis, previously thought to require an NSAID for relief, responds well to acetaminophen most of the time.

However, there are a few conditions for which you'll need the anti-inflammatory effect of an NSAID in order to get relief. These include arthritis pain that doesn't respond to acetaminophen, and menstrual cramps, which are triggered by prostaglandin and blocked by an NSAID.

So, if you take low-dose aspirin regularly, you have three options for pain relief: take acetaminophen along with it, take higher doses of aspirin, or take another NSAID for a short period of time, with your doctor's okay. This last situation might apply to people whose doctor thought that the benefits of low-dose aspirin outweighed the slightly increased risk they'd have from taking another NSAID. Although other NSAIDs have similar effects on blood platelets (one of the reasons for taking low-dose aspirin), they haven't been proven to work as well as aspirin does.

If you happen to need both low-dose aspirin and another NSAID for long-term therapy, you might ask your doctor about ways to lower your risk of serious side effects. For one thing, you should use an NSAID with a low risk of stomach bleeding. There aren't that many studies to show which NSAID is best, but over-the-counter ibuprofen and the prescription drug nabumetone (Relafen) seem to have lower risks of bleeding than some others.

Anther option is to take the drug misoprostol (Cytotec) along with an NSAID. This drug counteracts the harmful effects of NSAIDs on your stomach. However, it's expensive and causes side effects of its own, including stomach cramps and diarrhea. All in all, it's a matter of weighing the risks of treatment against no treatment. Not every pain needs a pill, and, depending on the condition, there are many non-drug remedies you can try, including ice, heat, manipulation, massage, exercise and others.

In a recent column on the risks associated with receiving a blood transfusion, I said that the risk of becoming infected with HIV, the AIDS virus, was about one in 225,000. However, a recent study shows that new tests to screen blood for HIV have lowered this risk to between 1 in 450,000 to 1 in 660,000. I thank the American Red Cross and the American Association of Blood Banks for calling this study to my attention. Jay Siwek, a family physician from Georgetown University, practices at the Fort Lincoln Family Medicine Center and Providence Hospital in Northeast Washington. Consultation is a health education column and is not a substitute for medical advice from your physician.Send questions to Consultation, Health Section, The Washington Post, 1150 15th St. NW, Washington, D.C. 20071. Questions cannot be answered personally.

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