Version July 2025
Antacid or pain: Adults <60 years: Oral: Note: Do not use the maximum dose for >10 days
Aspirin 325 mg/citric acid 1,000 mg/sodium bicarbonate 1,700 mg: 2 tablets every 4 hours (maximum: 8 tablets per 24 hours)
Aspirin 325 mg/citric acid 1,000 mg/sodium bicarbonate 1,916 mg: 2 tablets every 4 hours (maximum: 8 tablets per 24 hours)
Aspirin 500 mg/citric acid 1,000 mg/sodium bicarbonate 1,985 mg: 2 tablets every 6 hours (maximum: 7 tablets per 24 hours)
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer’s labeling
There are no dosage adjustments provided in the manufacturer’s labeling
Antacid/pain: Adults ≥60 years: Oral: Note: Do not use the maximum dose for >10 days
Aspirin 325 mg/citric acid 1,000 mg/sodium bicarbonate 1,700 mg: 2 tablets every 4 hours (maximum: 4 tablets per 24 hours)
Aspirin 325 mg/citric acid 1,000 mg/sodium bicarbonate 1,916 mg: 2 tablets every 4 hours (maximum: 4 tablets per 24 hours)
Aspirin 500 mg/citric acid 1,000 mg/sodium bicarbonate 1,985 mg: 2 tablets every 6 hours (maximum: 3 tablets per 24 hours)
Antacid or pain: Children ≥12 years and Adolescents: Oral: Refer to adult dosing
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
See aspirin and sodium bicarbonate monographs.
OTC labeling: When used for self-medication, do not use if you are allergic to aspirin, any other pain reliever/fever reducer, or any component of the formulation; concomitant use with prescription medication for gout, diabetes, or arthritis (Medi-Seltzer only)
Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Concerns related to adverse effects:
• Drug reaction with eosinophilia and systemic symptoms: Potentially serious, sometimes fatal, drug reaction with eosinophilia and systemic symptoms (DRESS), also known as multiorgan hypersensitivity reactions, has been reported with NSAIDs. Monitor for signs and symptoms (eg, fever, rash, lymphadenopathy, eosinophilia) in association with other organ system involvement (eg, hepatitis, nephritis, hematological abnormalities, myocarditis, myositis). Early symptoms of hypersensitivity reaction (eg, lymphadenopathy, fever) may occur without rash; discontinue therapy and further evaluate if DRESS is suspected.
• GI bleeding: Aspirin may cause severe stomach bleeding; risk factors include patients ≥60 years; history of stomach ulcers or bleeding problems; coadministration with anticoagulants or steroids; coadministration with other NSAIDs; ≥3 alcoholic drinks every day during therapy; and prolonged use or administration of more than the recommended dose.
• Hypersensitivity: Aspirin may cause a severe allergic reaction, including hives, skin reddening, facial swelling, rash, asthma, blisters, and/or shock. If an allergic reaction occurs, discontinue use immediately.
• Salicylate sensitivity: Patients with sensitivity to tartrazine dyes, nasal polyps, and asthma may have an increased risk of salicylate sensitivity.
Disease-related concerns:
• Ethanol use: Heavy ethanol use (>3 drinks/day) can increase bleeding risks and may enhance gastric mucosal damage.
Special populations:
• Pediatric: Children and teenagers who have or are recovering from chickenpox or flu-like symptoms should not use this product. Changes in behavior (along with nausea and vomiting) may be an early sign of Reye's syndrome; patients should be instructed to contact their healthcare provider if these occur.
Other warnings/precautions:
• Self-medication (OTC use): When used for self-medication, do not exceed recommended dose. Contact a health care provider before use if you have a history of GI problems (including ulcers) and stomach problems that last or come back (heartburn, upset stomach, pain); bleeding problems; are on a sodium-restricted diet; coadministration with a diuretic, anticoagulant or a prescription medication for diabetes, gout, or arthritis, or if you have asthma, hypertension, cardiac disease, hepatic cirrhosis, or renal disease. Discontinue use if any of the following occur: feeling faint; vomiting blood; bloody or black stools; stomach pain that does not get better; pain gets worse or lasts >10 days; fever gets worse or lasts >3 days; difficulty swallowing; ringing in the ears or loss of hearing; redness or swelling in the painful area; or any new symptoms appear.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Tablet Effervescent, Oral:
Alka-Seltzer: Aspirin 325 mg, citric acid 1000 mg, and sodium bicarbonate 1916 mg [contains sodium 567 mg/tablet]
Alka-Seltzer: Aspirin 325 mg, citric acid 1000 mg, and sodium bicarbonate 1700 mg [contains phenylalanine 9 mg/tablet, sodium 504 mg/tablet, sodium benzoate; lemon lime flavor]
Alka-Seltzer Extra Strength: Aspirin 500 mg, citric acid 1000 mg, and sodium bicarbonate 1985 mg [contains sodium 588 mg/tablet]
GoodSense Antacid/Pain Relief: Aspirin 325 mg, citric acid 1000 mg, and sodium bicarbonate 1916 mg
Medi-Seltzer: Aspirin 325 mg, citric acid 1000 mg, and sodium bicarbonate 1916 mg
No
Tablet, effervescent (Alka-Seltzer Oral)
325-1000-1916 mg (per each): $0.16
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Oral: Prior to administration, fully dissolve each dose (2 tablets) in 120 mL of water
Oral: Prior to administration, fully dissolve each dose (2 tablets) in 120 mL of water
Antacid: Temporary relief of heartburn, acid indigestion, and sour stomach when accompanied with headache or body aches and pains; upset stomach with headache from overindulgence in food or drink
Pain: Temporary relief of headache, body aches, and pain
Beers Criteria: Aspirin, when used chronically at doses more than 325 mg/day, is identified in the Beers Criteria as a potentially inappropriate medication to be avoided in patients ≥65 years of age (unless alternative agents ineffective and patient can receive concomitant gastroprotective agent) due to increased risk of GI bleeding and peptic ulcer disease in older adults in high-risk category (eg, >75 years of age or receiving concomitant oral/parenteral corticosteroids, anticoagulants, or antiplatelet agents). In addition, avoid for short-term scheduled use in combination with oral/parenteral corticosteroids, anticoagulants, or antiplatelet agents unless alternatives are ineffective and patient can receive concomitant gastroprotective agent (Beers Criteria [AGS 2023]).
KIDs List: Salicylates, when used in pediatric patients <18 years of age with suspicion of viral illness (influenza, chickenpox), are identified on the Key Potentially Inappropriate Drugs in Pediatrics (KIDs) list and should be used with caution due to risk of Reye syndrome (weak recommendation; very low quality of evidence) (PPA [Meyers 2020]).
Refer to individual components.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Abrocitinib: Aspirin may increase antiplatelet effects of Abrocitinib. Management: Do not use aspirin at doses greater than 81 mg/day with abrocitinib during the first 3 months of abrocitinib therapy. The abrocitinib prescribing information lists this combination as contraindicated. Risk D: Consider Therapy Modification
Acalabrutinib: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Aducanumab: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Agents with Blood Glucose Lowering Effects: Salicylates may increase hypoglycemic effects of Agents with Blood Glucose Lowering Effects. Risk C: Monitor
Ajmaline: Salicylates may increase adverse/toxic effects of Ajmaline. Specifically, the risk for cholestasis may be increased. Risk C: Monitor
Alcohol (Ethyl): May increase adverse/toxic effects of Aspirin. Specifically, alcohol may increase the bleeding risk of aspirin. Alcohol (Ethyl) may decrease therapeutic effects of Aspirin. Specifically, alcohol may interfere with the controlled release mechanism of extended release aspirin. Risk C: Monitor
Alendronate: Aspirin may increase adverse/toxic effects of Alendronate. Specifically, the incidence of upper gastrointestinal adverse events may be increased Risk C: Monitor
Aluminum Hydroxide: Citric Acid Derivatives may increase absorption of Aluminum Hydroxide. Risk C: Monitor
Ammonium Chloride: May increase serum concentration of Salicylates. Risk C: Monitor
Anagrelide: May increase antiplatelet effects of Aspirin. Risk C: Monitor
Angiotensin-Converting Enzyme Inhibitors: Salicylates may decrease therapeutic effects of Angiotensin-Converting Enzyme Inhibitors. Salicylates may increase nephrotoxic effects of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor
Anticoagulants (Miscellaneous Agents): Aspirin may increase anticoagulant effects of Anticoagulants (Miscellaneous Agents). Risk C: Monitor
Antiplatelet Agents (P2Y12 Inhibitors): Therapeutic Antiplatelets may increase antiplatelet effects of Antiplatelet Agents (P2Y12 Inhibitors). Risk C: Monitor
Benzbromarone: Salicylates may decrease therapeutic effects of Benzbromarone. Risk C: Monitor
Calcium Channel Blockers (Nondihydropyridine): May increase antiplatelet effects of Aspirin. Risk C: Monitor
Caplacizumab: May increase antiplatelet effects of Therapeutic Antiplatelets. Management: Avoid this combination if possible. If coadministration is required, monitor closely for bleeding. Interrupt caplacizumab if clinically significant bleeding occurs and administer von Willebrand factor concentrate to rapidly correct hemostasis, if needed. Risk D: Consider Therapy Modification
Carbonic Anhydrase Inhibitors: Salicylates may increase adverse/toxic effects of Carbonic Anhydrase Inhibitors. Salicylate toxicity might be enhanced by this same combination. Management: Avoid these combinations when possible.Dichlorphenamide use with high-dose aspirin as contraindicated. If another combination is used, monitor patients closely for adverse effects. Tachypnea, anorexia, lethargy, and coma have been reported. Risk D: Consider Therapy Modification
ClomiPRAMINE: May increase antiplatelet effects of Aspirin. Risk C: Monitor
Collagenase (Systemic): Aspirin may increase adverse/toxic effects of Collagenase (Systemic). Specifically, the risk of injection site bruising and or bleeding may be increased. Risk C: Monitor
Corticosteroids (Systemic): Salicylates may increase adverse/toxic effects of Corticosteroids (Systemic). These specifically include gastrointestinal ulceration and bleeding. Corticosteroids (Systemic) may decrease serum concentration of Salicylates. Withdrawal of corticosteroids may result in salicylate toxicity. Risk C: Monitor
Dasatinib: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Deoxycholic Acid: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Desirudin: Therapeutic Antiplatelets may increase anticoagulant effects of Desirudin. Risk C: Monitor
Dexibuprofen: Aspirin may increase adverse/toxic effects of Dexibuprofen. Dexibuprofen may decrease cardioprotective effects of Aspirin. Risk X: Avoid
Dexketoprofen: Salicylates may increase adverse/toxic effects of Dexketoprofen. Dexketoprofen may decrease therapeutic effects of Salicylates. Salicylates may decrease serum concentration of Dexketoprofen. Management: The use of high-dose salicylates (3 g/day or more in adults) together with dexketoprofen is inadvisable. Consider administering dexketoprofen 30-120 min after or at least 8 hrs before cardioprotective doses of aspirin to minimize any possible interaction. Risk X: Avoid
Dipyrone: May decrease antiplatelet effects of Aspirin. Management: Use caution and consider avoiding use of dipyrone in patients treated with aspirin for the treatment or prevention of cardiovascular events or stroke. Risk D: Consider Therapy Modification
Direct Oral Anticoagulants (DOACs): Aspirin may increase anticoagulant effects of Direct Oral Anticoagulants (DOACs). Risk C: Monitor
Donanemab: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Fondaparinux: Aspirin may increase anticoagulant effects of Fondaparinux. Management: Discontinue aspirin prior to fondaparinux therapy, if possible. If co-administration is required use caution and monitor for bleeding. Risk D: Consider Therapy Modification
Ginkgo Biloba: May increase anticoagulant effects of Salicylates. Management: Consider alternatives to this combination of agents. Monitor for signs and symptoms of bleeding (especially intracranial bleeding) if salicylates are used in combination with ginkgo biloba. Risk D: Consider Therapy Modification
Glycoprotein IIb/IIIa Inhibitors: Therapeutic Antiplatelets may increase anticoagulant effects of Glycoprotein IIb/IIIa Inhibitors. Risk C: Monitor
Heparin: Aspirin may increase anticoagulant effects of Heparin. Risk C: Monitor
Heparins (Low Molecular Weight): Aspirin may increase anticoagulant effects of Heparins (Low Molecular Weight). Risk C: Monitor
Herbal Products with Anticoagulant/Antiplatelet Effects: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Hyaluronidase: Salicylates may decrease therapeutic effects of Hyaluronidase. Risk C: Monitor
Ibritumomab Tiuxetan: Therapeutic Antiplatelets may increase antiplatelet effects of Ibritumomab Tiuxetan. Risk C: Monitor
Ibrutinib: Therapeutic Antiplatelets may increase adverse/toxic effects of Ibrutinib. Specifically, the risks of bleeding and hemorrhage may be increased. Risk C: Monitor
Icosapent Ethyl: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Influenza Virus Vaccine (Live/Attenuated): May increase adverse/toxic effects of Salicylates. Specifically, Reye's syndrome may develop. Risk X: Avoid
Inotersen: Therapeutic Antiplatelets may increase adverse/toxic effects of Inotersen. Specifically, the risk of bleeding may be increased. Risk C: Monitor
Ketorolac (Nasal): May increase adverse/toxic effects of Aspirin. An increased risk of bleeding may be associated with use of this combination. Ketorolac (Nasal) may decrease cardioprotective effects of Aspirin. Management: Concurrent use of nasal ketorolac with analgesic doses of aspirin is generally not recommended. If using low-dose, cardioprotective aspirin with nasal ketorolac, monitor the patient closely for evidence of adverse GI effects. Risk D: Consider Therapy Modification
Ketorolac (Systemic): May increase adverse/toxic effects of Aspirin. An increased risk of bleeding may be associated with use of this combination. Ketorolac (Systemic) may decrease cardioprotective effects of Aspirin. Risk X: Avoid
Lecanemab: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Limaprost: May increase adverse/toxic effects of Therapeutic Antiplatelets. Specifically, the risk of bleeding may be increased. Risk C: Monitor
Lipid Emulsion (Fish Oil Based): May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Loop Diuretics: Salicylates may decrease therapeutic effects of Loop Diuretics. Loop Diuretics may increase serum concentration of Salicylates. Risk C: Monitor
Macimorelin: Coadministration of Aspirin and Macimorelin may alter diagnostic results. Risk X: Avoid
Methotrexate: Salicylates may increase serum concentration of Methotrexate. Salicylate doses used for prophylaxis of cardiovascular events are not likely to be of concern. Management: Consider avoiding coadministration of methotrexate and salicylates. If coadministration cannot be avoided, monitor for increased toxic effects of methotrexate. Salicylate doses used for prophylaxis of cardiovascular events are not likely to be of concern. Risk D: Consider Therapy Modification
Miscellaneous Antiplatelets: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Multivitamins/Fluoride (with ADE): May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Multivitamins/Minerals (with ADEK, Folate, Iron): May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Multivitamins/Minerals (with AE, No Iron): May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Nicorandil: Aspirin may increase adverse/toxic effects of Nicorandil. Specifically, the risk of gastrointestinal ulceration and hemorrhage may be increased. Risk C: Monitor
Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective): Aspirin may increase adverse/toxic effects of Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective). Specifically, the risk of gastrointestinal adverse effects may be increased. Management: Concurrent use of aspirin at doses beyond cardioprotective levels is not recommended. While concurrent use of low-dose aspirin with a COX-2 inhibitor is permissible, patients should be monitored closely for signs/symptoms of GI ulceration/bleeding. Risk D: Consider Therapy Modification
Nonsteroidal Anti-Inflammatory Agents (Nonselective): May decrease therapeutic effects of Aspirin. Aspirin may increase adverse/toxic effects of Nonsteroidal Anti-Inflammatory Agents (Nonselective). Specifically, the risk for bleeding may be increased. Aspirin may decrease serum concentration of Nonsteroidal Anti-Inflammatory Agents (Nonselective). Management: In general, avoid regular, frequent use of NSAIDs with aspirin whenever possible. If combined, monitor for increased bleeding and a reduced cardioprotective effect of aspirin. Risk D: Consider Therapy Modification
Nonsteroidal Anti-Inflammatory Agents (Topical): May increase adverse/toxic effects of Salicylates. Specifically, the risk of gastrointestinal (GI) toxicity is increased. Management: Coadministration of salicylates and topical NSAIDs is not recommended. If salicylates and topical NSAIDs are coadministered, ensure the benefits outweigh the risks and monitor for increased NSAID toxicities. Risk D: Consider Therapy Modification
Obinutuzumab: Therapeutic Antiplatelets may increase adverse/toxic effects of Obinutuzumab. Specifically, the risk of bleeding may be increased. Management: Consider avoiding coadministration of obinutuzumab and therapeutic antiplatelets, especially during the first cycle of obinutuzumab therapy. Risk D: Consider Therapy Modification
Omacetaxine: Aspirin may increase adverse/toxic effects of Omacetaxine. Specifically, the risk for bleeding-related events may be increased. Management: Avoid concurrent use of aspirin with omacetaxine in patients with a platelet count of less than 50,000/uL. Risk X: Avoid
Omega-3 Fatty Acids: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Pentosan Polysulfate Sodium: Therapeutic Antiplatelets may increase adverse/toxic effects of Pentosan Polysulfate Sodium. Specifically, the risk of hemorrhage may be increased. Risk C: Monitor
Pirtobrutinib: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Potassium Phosphate: May increase serum concentration of Salicylates. Risk C: Monitor
PRALAtrexate: Salicylates may increase serum concentration of PRALAtrexate. Salicylate doses used for prophylaxis of cardiovascular events are unlikely to be of concern. Management: Consider avoiding concomitant use of salicylates and pralatrexate. If coadministered, monitor for increased pralatrexate adverse effects. Salicylate doses used for prophylaxis of cardiovascular events are not likely to be of concern. Risk D: Consider Therapy Modification
Probenecid: Salicylates may decrease therapeutic effects of Probenecid. Salicylates may increase serum concentration of Probenecid. Probenecid may increase serum concentration of Salicylates. Risk X: Avoid
Salicylates: May increase anticoagulant effects of Salicylates. Risk C: Monitor
Selective Serotonin Reuptake Inhibitor: May increase antiplatelet effects of Aspirin. Risk C: Monitor
Selumetinib: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Serotonin/Norepinephrine Reuptake Inhibitor: May increase antiplatelet effects of Aspirin. Risk C: Monitor
Sincalide: Drugs that Affect Gallbladder Function may decrease therapeutic effects of Sincalide. Management: Consider discontinuing drugs that may affect gallbladder motility prior to the use of sincalide to stimulate gallbladder contraction. Risk D: Consider Therapy Modification
Spironolactone: Aspirin may decrease therapeutic effects of Spironolactone. Risk C: Monitor
Sucroferric Oxyhydroxide: May decrease serum concentration of Aspirin. Management: Administer aspirin at least 1 hour before administration of sucroferric oxyhydroxide. Risk D: Consider Therapy Modification
Sulfinpyrazone: Salicylates may decrease serum concentration of Sulfinpyrazone. Risk X: Avoid
Talniflumate: Aspirin may increase adverse/toxic effects of Talniflumate. Management: When possible, consider alternatives to this combination. Concurrent use is generally not recommended. Risk D: Consider Therapy Modification
Thiopental: Aspirin may decrease protein binding of Thiopental. Risk C: Monitor
Thrombolytic Agents: Therapeutic Antiplatelets may increase adverse/toxic effects of Thrombolytic Agents. Specifically, the risk of bleeding may be increased. Risk C: Monitor
Ticagrelor: Aspirin may increase antiplatelet effects of Ticagrelor. Aspirin may decrease therapeutic effects of Ticagrelor. More specifically, the benefits of ticagrelor relative to clopidogrel may be diminished in adult patients receiving daily aspirin doses greater than 100-150 mg daily. Management: Avoid maintenance aspirin doses greater than 150 mg/day in patients receiving ticagrelor. After any initial dose, only low-dose aspirin (75 to 100 mg/day) is recommended. Risk D: Consider Therapy Modification
Tipranavir: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Valproic Acid and Derivatives: Salicylates may increase serum concentration of Valproic Acid and Derivatives. Risk C: Monitor
Varicella Virus-Containing Vaccines: Salicylates may increase adverse/toxic effects of Varicella Virus-Containing Vaccines. Specifically, the risk for Reye's syndrome may increase. Risk X: Avoid
Vitamin E (Systemic): May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Vitamin K Antagonists: Aspirin may increase anticoagulant effects of Vitamin K Antagonists. Risk C: Monitor
Volanesorsen: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Zanubrutinib: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Refer to individual monographs.
Refer to individual monographs.
Some products may contain phenylalanine and/or sodium
Aspirin: Irreversibly inhibits cyclooxygenase-1 and 2 (COX-1 and 2) enzymes, via acetylation, which results in decreased formation of prostaglandin precursors; irreversibly inhibits formation of prostaglandin derivative, thromboxane A2, via acetylation of platelet cyclooxygenase, thus inhibiting platelet aggregation; has antipyretic, analgesic, and anti-inflammatory properties.
Citric acid: Antacid used in effervescing mixtures.
Sodium bicarbonate: Dissociates to provide bicarbonate ion which neutralizes acid secretions in the GI tract.
Refer to individual agents.
