Q. I heard recently that ibuprofen counteracts the beneficial heart effect that a daily aspirin has. I take a baby aspirin a day because I have had angioplasty. I also have a bad back and take ibuprofen for it daily.

Is there a time-frame of impact? In other words, could I take aspirin at night and ibuprofen the next day without losing aspirin’s effectiveness?

A. There is growing evidence that ibuprofen (Advil, Motrin, etc) may compromise the heart benefits of low-dose aspirin. Platelets are the part of blood that stick together to form a blood clot. Aspirin prevents this clotting action, which is how it helps reduce the risk of heart attacks and strokes.

An article in the New England Journal of Medicine (Dec. 20, 2001) demonstrated that regular use of ibuprofen can prevent aspirin’s anti-clotting effect. A follow-up study from The Lancet (Feb. 15, 2003) recently confirmed that heart patients taking both aspirin and ibuprofen were at higher risk of premature death than those taking aspirin alone.

If you take ibuprofen daily, you probably won’t benefit from aspirin. But if you take ibuprofen occasionally, make sure you take your aspirin two hours beforehand to give it a head start. Acetaminophen (Tylenol) and the prescription arthritis medicine diclofenac (Voltaren) do not appear to reduce the benefits of aspirin.

Q. I read with interest the letter from a constipated traveler. The minute I get in a car I have the opposite problem. Just going to the beauty shop or out shopping, I barely get on the road and I have to find a rest room. Sometimes I don’t make it.

I like to go on trips with my children, but I’m afraid they will stop asking me to go along because I might have to make two or three rest stops. Is there anything that can help?

A. The prescription drug Lotronex was recently permitted back on the market for irritable bowel syndrome (IBS) associated with diarrhea. It is controversial because of potentially serious side effects. If your doctor determines that it is appropriate, you will need close monitoring.

Many people claim that coconut can help chronic diarrhea. We learned from Donald Agar years ago that eating two coconut macaroon cookies a day alleviated his chronic diarrhea.

We recently heard this from another reader: “I’ve had IBS, mostly diarrhea, for 20 years. After reading your column I went and purchased coconut macaroons and ate two of them in the parking lot. By the next day, I was fine and have been ever since (nearly two years). I find I need only one cookie a day.”

We discuss diarrhea, gas and other gastrointestinal woes in our Guide to Digestive Distress, which we are sending you. Anyone who would like a copy, please send $2 in check or money order with a long (no. 10) stamped (60 cents), self-addressed envelope: Graedons’ People’s Pharmacy, No. G-3, P. O. Box 52027, Durham, NC 27717-2027.

Q. When I told my doctor that coffee gives me heartburn, he gave me a free sample of Prevacid. I took it every day for a while and it worked. I still have a few left. Would they help if I took them only on days when I plan to drink coffee?

A. Prevacid is a potent acid inhibitor, but it needs time to take effect. If you take it a couple of hours before your coffee, it should do the job.

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