Alternative names: Acetylsalicylic Acid
Aspirin is one of the most widely-used medications in the world, with over 40,000 tons being consumed each year. A great body of evidence also suggests that regular aspirin use may offer strong protection against the consequences of heart attack, liver disease, and various cancers.
Other drugs with similar medicinal properties to aspirin have subsequently been developed, being collectively known as the non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs such as aspirin, indomethacin, piroxicam and sulindac are valuable drugs for the alleviation of pain, inflammation and fever. NSAIDs are widely used in the treatment of inflammatory musculoskeletal diseases such as arthritis. Of all of the NSAIDs, aspirin is the most widely used since it is inexpensive, easily available and is indicated in many common conditions such as headache and the common cold.
Aspirin is a well-established and relatively safe drug, having first been isolated in 1897, and previously being used for 3,000 years in the form of tea made from boiling the bark of the white willow, which contains salicylic acid. Its medicinal properties have been recognized since the days of the Assyrians and the Egyptians.
Enteric-coated aspirin, such as 81mg Bayer, (120 count) or a generic variety, is recommended over the child's aspirin, which are generally found in a tamper-proof bottle with a count of only 20 or so.
Aspirin is used to prevent blood clots within the blood vessel wall, be it in the heart vessels which can cause a heart attack, or in the neck and head vessels which can cause a stroke. The basis for the use of low dose aspirin lies in its unique inhibitory effect on a single key enzyme, COX-1 (cyclooxygenase-1). Actually, there are two forms (isoforms) of COX. The other is known as COX-2. The latter is inducible and undetectable in most normal tissues but under certain conditions such as inflammatory processes, becomes elevated. Therefore, a high dose of aspirin (10 grains or 2 adult tablets), which is an anti-inflammatory, and other medications such as ibuprofen quell the COX-2 and the inflammatory process. As a consequence of this, the good effects of COX-2, which gives protection of the stomach and kidneys are lost and problems with this such as ulcers, gastrointestinal bleeding, kidney failure, fluid retention and high blood pressure can occur with the higher dosage.
The therapeutic and toxic properties of aspirin and other NSAIDs can be explained pharmacologically. NSAIDs inhibit the cyclooxygenase enzyme and thus prevent the formation of prostaglandins and thromboxanes from precursor arachidonic acid. Arachidonic acid is an essential polyunsaturated fatty acid that is derived from the diet. It is believed that the analgesic, anti-inflammatory and antipyretic effects of aspirin are related to prostaglandin inhibition.
It is believed that the therapeutic effects of NSAIDs against pain, inflammation and fever are largely related to cyclo-oxygenase-2 inhibition while the toxic effects of NSAIDs to the stomach and kidney are largely related to cyclo-oxygenase-1 inhibition.
Aspirin is absorbed and goes directly to the liver. The liver inactivates the aspirin by deacetylation. A transdermal patch may be available soon that will not do this, in that it would go right into the blood stream to do its good thing of preventing excess blood clotting.
Aspirin also has a unique usefulness among the family of NSAIDs in that it can reduce the risk of cardiovascular disease. Low doses (100-300mg per day) can reduce by 30% the risk of myocardial infarction and stroke among patients who already have a history of these disorders; lower doses of between 75-150mg per day are also showing promise in reducing the risk of cardiovascular disease in patients with a pre-existing condition. The prevention of cardiovascular disease is thought to be related to thromboxane inhibition in platelets leading to a reduced risk of potentially dangerous blood clots forming in the heart and brain blood vessels.
Aspirin has also been shown to decrease the incidence of gastrointestinal cancer and gall bladder disease, and improve diabetes, PMS symptoms, and pregnancy outcomes. The American Cancer Society epidemiologists found that while low dose aspirin use had no effect on cancers of most organ systems, the risks were greatly reduced for fatal cancers of the esophagus, stomach, rectum and colon. These four digestive tract cancers were approximately 40% lower among men and women who used aspirin 16 times per month or more for at least one year compared to those who used no aspirin.
As with heart disease, studies have shown that taking low doses of aspirin, and maintaining a diet low in fat and high in fiber-grains, fruits and vegetables-reduces the risk of many of the digestive cancers.
When cholesterol-saturated bile accumulates and becomes lodged in the cystic duct, gallstones are formed. During acute cholecystitis, usually a bacterial inflammation associated with gallstones, the production of prostaglandins are increased as part of the normal inflammation and repair processes. This process involves much pain, increased fluid secretions, muscle contraction and decreased bile, all of which perpetuate the inflammation more. Several studies have been conducted to show that prostaglandin inhibitors such as aspirin and non-steroidal anti-inflammatory drugs can prevent the formation of gallstones, as well as reduce the biliary pain associated with this process.
Years ago, researchers noticed a link between arthritis, leprosy and the incidence of Alzheimer's. As part of the standard treatment for arthritis and leprosy was the use of aspirin. These patients were proven to have a lower incidence of Alzheimer's. Researchers from Johns Hopkins Alzheimer's Disease Research Center found that as the use of aspirin and other non-steroidal anti-inflammatory drugs increases, the rate of mental deterioration decreases. In the November 8, 1999 issue of Business Week, a pharmaceutical report indicated anti-inflammatory drugs reduce the inflammation that accompanies plaque formation in the brain. Also, population studies have long noted that aspirin and other nonsteroidal anti-inflammatory drugs appear to reduce the risk of Alzheimer's by 50%."
Many small studies have concluded that low dose aspirin reduces the risks of pregnancy induced hypertension toxemia and severe low birth weight.
When an analgesic is needed, read the label to make sure you do not take a product that contains additional aspirin. Acetaminophen (generic Tylenol) certainly is a good substitute.
Despite their beneficial effects, aspirin and other NSAIDs do have toxic side-effects. Aspirin can reduce kidney function, induce bronchoconstriction in asthmatics and in rare cases may precipitate hemorrhagic stroke.
Although aspirin has in the past been associated with an increased risk of stomach bleeding and ulcers, researchers have now found that the stomach bleeding is not caused by the aspirin, but by a "bug". A Nottingham University study showed that 60% of patients suffering from stomach bleeding while taking a low-dose aspirin also tested positive for the bacterium H. pylori. Once the bacterium was removed, patients no longer had an increased risk of stomach bleeding when taking aspirin, and they did not suffer other recurring ulcer symptoms.
Note: Children should never be given aspirin or aspirin-containing cold medications because of the risks for developing Reye's syndrome, a severe acquired metabolic disease associated with liver and brain dysfunction and death.
Aspirin can prevent stomach enzymes from processing the alcohol. If taking aspirin, leave more time between drinks so the liver can cope.
If you are at risk of having a heart attack, taking one aspirin daily can greatly reduce this risk. A quarter of heart attacks occur within three hours of waking up, when the blood is thickest and stickiest and the circulation is at its slowest, increasing the risk of clot formation. Therefore, the most effective time to take aspirin for the prevention of heart attack, stroke and deep vein thrombosis is before sleeping.
During a heart attack, it is important to get some aspirin into your bloodstream as quickly as possible by chewing 1 adult-strength or 2 to 4 low-dose aspirin. Most heart attacks occur when a cholesterol-laden plaque ruptures in a coronary artery, attracting platelets to its surface and causing a clot (thrombus) to build up. If the clot blocks the artery completely, it deprives part of the heart of oxygen and causes a heart attack. Aspirin helps by inhibiting platelets; only a tiny amount is needed to inhibit all the platelets in the bloodstream – in fact, small doses are better. This will slow clotting and decrease the size of the blood clot that is forming.
After a heart attack, aspirin can help prevent further attacks when taken daily. An appropriate preventative dose is around half a regular aspirin tablet (150-160mg), or two baby aspirin tablets (81mg each).
Research at the University of Oxford published in 2017 suggests that regular aspirin users without a history of heart attack or stroke should stop taking aspirin by their late 60s because after that age the risk of fatal bleeding probably outweighs the benefits.
A further study, published in the New England Journal of Medicine in September 2018, confirmed no detectable benefit from regular use of low-dose aspirin for those 70 and older who are at low-to-moderate risk of heart disease; instead it found an increase in the rate of death in that population.
Those under 20 should not take aspirin unless a doctor approves it. In children and teens, aspirin taken for viral illnesses has been associated with the potentially fatal disease Reye syndrome.
By all means take some pain relief tablets, but avoid aspirin as the alcohol has probably already made your stomach lining sensitive.
Aspirin is the preferred drug for therapy given as 80-100mg/kg/day. Higher doses are usually reserved for children with more severe disease. Serum salicylate levels should be maintained between 20 and 30mg/dl. Liver enzymes should be monitored prior to and during aspirin therapy. Some elevation of liver enzymes almost always occurs. Treatment, in the absence of overt side-effects, should be continued for 6 months beyond any indication of active disease and therapy should be tapered slowly. Prednisone in a dose of 1mg/kg/day may be used for brief periods. Physical therapy of the involved joints is essential in preventing long-term disability.
Among the more common predisposing factors for hyperuricemia are kidney failure from any cause, diuretics, dehydration, hormonal diseases, alcohol consumption and using low doses of aspirin. Aspirin and aspirin-containing products should be avoided during acute attacks because they will further elevate uric acid levels.
People who take aspirin daily have a 36% reduced likelihood of developing metastatic cancer, according to a meta-analysis published in 2012.
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