Aspirin (as pir in)

Other Names: ASA, acetylsalicylic acid

Introduced: 1899

Prescription: USA: No Canada: No

Available as Generic: Yes

Class: Mild analgesic, anti-inflammatory, antiplatelet, antipyretic, salicylates

Controlled Drug: USA: No Canada: No

Brand Names: Alka-Seltzer Effervescent Pain Reliever & Antacid [CD], Alka-Seltzer Plus [CD], ♦Aspirin*, Bayer Aspirin, Bayer Children's Chewable As­pirin, Bufferin [CD], Bufferin w/Codeine [CD], 4-Way Cold Tablets [CD], ♦Oxycodan [CD], Percodan [CDTrigesic [CD]

Principal Uses

As a Single Drug Product: To relieve mild to moderate pain from any cause, to provide symptomatic relief in conditions characterized by inflammation and to reduce high fever. A major use is to treat musculoskeletal disorders, especially acute and chronic arthritis. It is also used selectively in low dosage to prevent platelet embolism to the brain (in men) and to reduce the risk of thromboembolism in patients recovering from a recent heart attack, in those with artificial heart valves and in those undergoing hip surgery.

As a Combination Drug Product [CD]: Frequently combined with other mild or strong analgesic drugs to enhance pain relief. Also combined with antihistamines and decongestants in many cold preparations to relieve the headache and general discomfort that often accompany respiratory infections.

How This Drug Works: Aspirin reduces the tissue concentrations of prosta­glandins, chemicals involved in the production of inflammation and pain. By modifying the temperature-regulating center in the brain, dilating blood vessels in the skin, and increasing sweating, aspirin hastens the loss of body heat and reduces fever. By preventing the production of thromboxane in blood platelets, aspirin inhibits the aggregation of platelets and the initiation of blood clots.

Available Dosage Forms and Strengths

Capsules, enteric-coated — 500 mg Capsules, enteric-coated granules — 325 mg

Gum tablets — 227.5 mg

Suppositories — 60 mg, 120 mg, 125 mg, 130 mg, 195 mg, 200 mg, 300 mg, 325 mg, 600 mg, 650 mg, 1.2 grams Tablets — 65 mg, 81 mg, 325 mg, 500 mg Tablets, chewable — 81 mg

Tablets, enteric-coated — 325 mg, 500 mg, 650 mg, 975 mg Tablets, prolonged-action — 650 mg, 800 mg

Usual Adult Dosage Range: For pain or fever—325 to 650 mg/4 hours as needed. For arthritis (and related conditions)—3600 to 5400 mg daily

80 to 150 mg/24 to 48 hours. Note: For long-term use, actual dosage and administration schedule must be determined by the physician for each patient individually.

Dosing Instructions: Take with food, milk, or a full glass of water to reduce

stomach irritation. Regular tablets may be crushed and capsules opened for administration. Enteric-coated tablets, prolonged-action tablets, A.S.A. Enseals, Cama tablets and Ecotrin tablets should not be crushed.

Usual Duration of Use: Short-term use is recommended—3 to 5 days. Daily use should not exceed 10 days without physician supervision. Continual use on a regular schedule for 1 week is usually necessary to determine this drug's effectiveness in relieving the symptoms of chronic arthritis. Long-term use requires periodic evaluation of response and dosage adjustment. Consult your physician on a regular basis.

This Drug Should Not Be Taken If

• you have had an allergic reaction or unfavorable response to any form of aspirin previously.

• you have any type of bleeding disorder (such as hemophilia).

• you have active peptic ulcer disease.

• you are in the last 3 months of pregnancy.

• it has an odor resembling vinegar. This is due to the presence of acetic acid and indicates the decomposition of aspirin.

• Inform Your Physician Before Taking This Drug If

• you are taking any anticoagulant drug.

• you are taking oral antidiabetic drugs.

• you have a history of peptic ulcer disease or gout.

• you have lupus erythematosus.

• you are pregnant or planning pregnancy.

• you plan to have surgery of any kind in the near future.

Possible Side-Effects (natural, expected and unavoidable drug actions) Mild drowsiness in sensitive individuals.

Possible Adverse Effects (unusual, unexpected and infrequent reactions) If any of the following develop, consult your physician promptly for guidance.

Mild Adverse Effects

Allergic Reactions: Skin rash, hives, nasal discharge (resembling hay fever), nasal polyps. Stomach irritation, heartburn, nausea, vomiting, constipation.

Serious Adverse Effects

Allergic Reactions: Acute anaphylactic reaction: asthma, unusual bruising due to allergic destruction of blood platelets. Idiosyncratic Reactions: Hemolytic anemia

Erosion of stomach lining, with silent bleeding.

Activation of peptic ulcer, with or without hemorrhage.

Bone marrow depression: fatigue, weakness, fever, sore throat, abnormal bleeding or bruising.

Hepatitis with jaundice: yellow skin and eyes, dark-colored urine, light-colored stool (very rare).

Kidney damage, if used in large doses or for a prolonged period of time.

Possible Effects on Sexual Function: None reported.

Adverse Effects That May Mimic Natural Diseases or Disorders

Liver damage may suggest viral hepatitis.

Possible Effects on Laboratory Tests

Complete blood cell counts: decreased red cells, hemoglobin, white cells and platelets.

Bleeding time: prolonged.

Prothrombin time: increased by large doses; decreased by small doses.

Blood glucose level: decreased in diabetics.

Blood uric acid level: increased by small doses; decreased by large doses.

Liver function tests: increased liver enzymes (ALT/GPT, AST/GOT, alkaline phosphatase).

Kidney function tests: increased blood creatinine and urea nitrogen levels with long-term use; increased protein and kidney cells in urine.

Thyroid function tests: increased T3 uptake, free T3 and free T4; de­creased TSH, T3, T4, and free thyroxine index (FTI).

Pregnancy tests: large doses of aspirin may cause a false positive urine test (mouse and rabbit tests).

Urine sugar tests: false positive with Clinitest or Benedict's solution.

Fecal occult blood test: positive with large doses of aspirin.

CAUTION

1. It is most important to understand that aspirin is a drug. While it is one of our most useful drugs, we have an unrealistic sense of safety and unconcern regarding its action within the body and its potential for adverse effects.

2. In order to know if you are taking aspirin, make it a point to learn the contents of all drugs you take—those prescribed by your physician and those you purchase over-the-counter (OTC) without prescription.

3. Limit the dose of aspirin to no more than 3 tablets (975 mg) at one time, allow at least 4 hours between doses and take no more than 10 tablets (3250 mg) in 24 hours without physician supervision.

4. Remember that aspirin can

• cause new illnesses.

• complicate existing illnesses.

• complicate pregnancy.

• complicate surgery.

• interact unfavorably with other drugs.

5. When your physician asks "Are you taking any drugs?" the answer is yes if you are taking aspirin. This also applies to any nonprescription drug you may be taking.

Precautions for Use

By Infants and Children: Reye syndrome (brain and liver damage in children, often fatal) can follow flu or chicken pox in children and teenagers. While the exact cause and nature of the syndrome are not known, some reports suggest that the use of aspirin by children with flu or chicken pox can increase the risk of developing this complication. Consult your physician before giving aspirin to a child or teenager with chicken pox, flu or similar infection.

Usual dosage schedule for children:

Up to 2 years of age—consult physician.

2 to 4 years of age—160 mg/4 hours, up to 5 doses/24 hours.

4 to 6 years of age—240 mg/4 hours, up to 5 doses/24 hours.

6 to 9 years of age—320 mg/4 hours, up to 5 doses/24 hours.

9 to 11 years of age—400 mg/4 hours, up to 5 doses/24 hours.

11 to 12 years of age—480 mg/4 hours, up to 5 doses/24 hours.

Do not exceed 5 days of continual use without consulting your physician.

Give all doses with food, milk or a full glass of water.

By Those over 60 Years of Age: The natural decline in kidney function can reduce your tolerance for aspirin. Observe for indications of excessive dosage: nervous irritabilty, confusion, ringing in the ears, deafness, loss of appetite, nausea and stomach irritation. Aspirin can cause excessive bleeding from the stomach in sensitive individuals. This can occur as "silent" bleeding of small amounts over an extended period of time, resulting in anemia. In addition, sudden hemorrhage can occur, even without a history of stomach ulcer. Observe stools for gray to black discoloration—an indication of stomach bleeding.

Advisability of Use During Pregnancy

Pregnancy Category: D (tentative). See Pregnancy Code inside back cover. Animal studies: Significant birth defects due to this drug have been reported.

Human studies: Information from studies of pregnant women indicates no increased risk of birth defects in 32,164 pregnancies exposed to aspirin. However, studies show that the regular use of salicylates dur­ing pregnancy is often detrimental to the health of the mother and to the welfare of the fetus. Excessive use of salicylate drugs can cause anemia, hemorrhage before and after delivery and an increased incidence of stillbirths and newborn deaths. It is advisable to limit the use of aspirin during pregnancy to small doses and for brief periods of time, and to avoid aspirin altogether during the last 3 months.

Advisability of Use if Breast-Feeding

Presence of this drug in breast milk: Yes.

Avoid drug or refrain from nursing.

Habit-Forming Potential: Use of this drug in large doses for a prolonged period of time may cause a form of psychological dependence.

Effects of Overdosage: Stomach distress, nausea, vomiting, ringing in the ears, dizziness, impaired hearing, sweating, stupor, fever, deep and rapid breathing, muscular twitching, delirium, hallucinations, convulsions.

Possible Effects of Long-Term Use

A form of psychological dependence.

Anemia due to chronic blood loss from erosion of stomach lining.

The development of stomach ulcer.

The development of "aspirin allergy"—nasal discharge, nasal polyps,

asthma.

Kidney damage. Excessive prolongation of bleeding time, of major importance in the event of injury or surgery.

Suggested Periodic Examinations While Taking This Drug (at physician's

discretion)

Complete blood cell counts. Kidney function tests and urine analyses. Liver function tests.

While Taking This Drug, Observe the Following

Foods: No restrictions.

Nutritional Support: If supplementing the diet with vitamin C, take no more

than the recommended daily allowance. Do not take large doses of

vitamin С while taking aspirin on a regular basis.

Beverages: No restrictions. May be taken with milk. Alcohol: No interactions expected. However, the concurrent use of alcohol and aspirin may significantly increase the possibility of erosion and ulceration of the stomach lining and may result in bleeding.

Tobacco Smoking: No interactions expected.

Other Drugs

Aspirin may increase the effects of

oral anticoagulants, and cause abnormal bleeding.

Dosage adjustment is often necessary.

oral antidiabetic drugs and insulin, and cause hypoglycemia (see Glossary). Dosage adjustment is often necessary.

heparin, and cause abnormal bleeding.

methotrexate, and increase its toxic effects.

valproic acid (Depakene). Aspirin may decrease the effects of

• beta-adrenergic-blocking drugs (see Drug Class, Section Four).

• captopril (Capoten).

• probenecid (Benemid), and reduce its effectiveness in the treatment of gout—with aspirin doses of less than 2 grams/24 hours.

• spironolactone (Aldactone), and reduce its diuretic effect.

• sulfinpyrazone (Anturane), and reduce its effectiveness in the treatment of gout—with aspirin doses of less than 2 grams/24 hours.

• The following drugs may increase the effects of aspirin

• acetazolamide (Diamox).

• para-aminobenzoic acid (Pabalate).

• vitamin C, taken as ascorbic acid and in large doses, may acidify the urine in some individuals and cause aspirin accumulation and toxicity.

• The following drugs may decrease the effects of aspirin

• antacids, in regular continual use.

• Cortisone like drugs.

• urinary alkalizers (sodium bicarbonate, sodium citrate).

Driving, Hazardous Activities: No restrictions or precautions.

Aviation Note: Usually no restrictions. However, it is advisable to observe

for the possible occurrence of mild drowsiness and to restrict activities

accordingly.

Exposure to Sun: No restrictions.

Discontinuation: The use of aspirin should be discontinued completely at least 1 week before surgery of any kind.

TEXT 3. Read the following text carefully and find out the sentences containing the words combination “blood cell count”.