Based on PubMed | Can I take aspirin on an empty stomach while fasting, or should I take it with food to reduce stomach irritation?

You can take aspirin while fasting, but taking it on an empty stomach may increase the chance of stomach irritation; if you notice upset, it’s generally advised to take it with food or milk and a full glass of water. ^{[1] [2]} Drinking a full glass of water with each dose is specifically recommended to help the tablet move down and reduce local irritation. ^[3]

Why stomach irritation happens

Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that can irritate the lining of the stomach and duodenum and reduce protective prostaglandins, which may lead to erosions or, in higher-risk situations, ulcer or bleeding. ^[4] Even short-term use can increase minor gastrointestinal symptoms like dyspepsia, nausea, or abdominal pain compared with placebo or other common cold/pain medicines. ^[5] Endoscopy studies show that aspirin can cause visible erosions and petechiae in the stomach and duodenum shortly after dosing, even in healthy volunteers. ^[6]

Fasting vs taking with food

• Taking aspirin on an empty stomach may make irritation more likely because the drug has direct topical contact with the stomach lining. ^[4]
• Over-the-counter labeling advises: “take with food or milk if stomach upset occurs,” which is a practical way to lessen irritation if you are prone to it or begin to feel discomfort. ^{[1] [2]}
• Regardless of food, using a full glass of water with each dose is recommended. ^[3]

Enteric-coated aspirin: does it help?

Enteric-coated (EC) aspirin is designed to dissolve in the intestine, which may reduce direct contact with the stomach lining. ^[7] Studies suggest EC aspirin can reduce some minor endoscopic lesions and lowers measured occult blood loss compared with plain aspirin, but it does not clearly reduce clinically important dyspepsia or bleeding events overall. ^{[8] [7]} In other words, EC tablets may be gentler locally but do not eliminate the risk of meaningful GI problems. ^[8]

Who is at higher risk and should be extra cautious

Some people have a higher chance of stomach bleeding with aspirin, such as older adults, those with a history of ulcers or GI bleeding, and those taking other NSAIDs, steroids, anticoagulants, or antiplatelet drugs. ^[9] If you’ve had prior stomach problems (like heartburn, ulcers, or bleeding), aspirin might not be advisable without medical guidance, and warnings on consumer labels highlight this. ^[10] Aspirin “stomach bleeding” warnings also apply to those who drink three or more alcoholic drinks daily. ^[10]

Practical tips if you must take aspirin while fasting

• Take with a full glass of water to help the tablet pass quickly and reduce local irritation. ^[3]
• If you develop stomach upset, consider taking with a small amount of food or milk, as labeling advises. ^{[1] [2]}
• Consider an enteric-coated formulation if you are sensitive, knowing it may reduce minor mucosal injury but doesn’t fully prevent significant GI events. ^[8]
• Avoid combining aspirin with other NSAIDs unless a clinician has advised it. ^[10]
• Seek medical advice about protective strategies (for example, a proton pump inhibitor) if you need daily aspirin and have risk factors for GI complications. ^[9]

When to stop and seek help

Stop aspirin and contact a clinician urgently if you notice any signs of stomach bleeding: black or bloody stools, vomiting blood, feeling faint, or persistent stomach pain that doesn’t improve. ^{[1] [2]}

Special situations

• Pregnancy: Do not use aspirin at 20 weeks or later in pregnancy unless specifically directed by a clinician, due to risks to the unborn baby and delivery complications. ^[3]
• Known aspirin/NSAID allergy, asthma with nasal polyps, or prior aspirin-induced ulcers/bleeding are important reasons to avoid aspirin unless your clinician advises otherwise. ^[10]

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Bottom line

• It’s possible to take aspirin while fasting, but doing so may increase stomach irritation for some people. ^[4]
• If you get stomach upset, taking it with food or milk and a full glass of water is recommended by consumer labeling. ^{[1] [2] [3]}
• If you’re at higher risk for GI problems or you need long-term aspirin talk with your clinician about safer strategies. ^[9]