(Republished with permission from the St. Louis Post-Dispatch. This article originally ran in the Healthy & Fit section on Monday, July 23, 2007)
By Harry Jackson Jr. St. Louis Post-Dispatch
Dr. Philip Majerus discovered a few decades ago that aspirin can help prevent heart attacks and stroke. Since then, Majerus, a professor at Washington University, has maintained a deep respect for this little white pill, which has been around since the 1800s.
“Aspirin is the most effective drug that we have,” Majerus says. “If we eliminated all but three drugs, aspirin would be one” of the three drugs we should keep, he says.
Much of America agrees with him. Aspirin is in virtually everyone’s medicine cabinet.
Doctors still like it because, while there’s a pill for every ailment aspirin addresses, aspirin is the only pill that takes care of so many conditions. Consumers still like it because it’s the least expensive and most versatile drug on the market.
“To the consumer, it is almost a miracle drug,” says Nimita Thekkepat, assistant professor of pharmacy at St. Louis College of Pharmacy. “It helps inflammation, fever, and it can save your life (from heart attack).”
Aspirin works by blocking the production of prostaglandins, the on-off switch in cells that regulate pain and inflammation, among other things. That’s why aspirin stops mild inflammation and pain. But that’s the blessing and the curse.
Prostaglandins are unique to each family of cells. Some versions are good; some versions promote pain; some versions constrict blood vessels and help platelets clot.
But to aspirin, the only good prostaglandin is a dead prostaglandin.
So while it blocks prostaglandins that cause pain or cause clotting and narrowing of the blood vessels and inflammation, it also blocks prostaglandins that protect the stomach lining.
That’s where stomach bleeding comes from when you take aspirin or other drugs in the aspirin family. They’re known as nonsteroidal anti-inflammatory drugs, or NSAIDs. Drugs in this family include ibuprofen (Motrin, Advil), naproxen (Aleve) and ketoprofen (Orudis). Aspirin causes the most irritation.
“Aspirin is the most toxic (painkiller) to the stomach,” says Dr. Richard Brasington, head of the Division of Rheumatology at Washington University School of Medicine.
Still, the versatility of aspirin allows a range of dosages for physical problems. For example, a very low dose — one pill of 81 milligrams compared with two pills of 325 milligrams for a full dose — will protect your cardiovascular system by preventing blood clots and relaxing constricted blood vessels, but it rarely upsets the stomach.
“Remember that the low-dose aspirin for (cardiovascular health) is a completely different drug than taking 20 aspirin a day for pain,” Brasington says.
Majerus agreed: “The effect on platelets is long-lasting at such a low dose that it doesn’t affect anything else.”
Some would consider aspirin semiretired as a pain reliever.
Sexier over-the-counter and prescription painkillers have eclipsed aspirin as the frontline pain remedy. They’re more powerful and longer-lasting. Prescription drugs do wonders for blood pressure and heart disease.
But while there’s a better drug for anything aspirin can do, no drug can do everything aspirin can do.
“I think of it more as an anti-platelet,” Thekkepat says. “I don’t think of it as much as a (painkiller).
“It’s a good anti-inflammatory agent, but we have other drugs out there for that. I think it has to create anti-platelet effects.”
Still, it has some advantages.
Brasington named a few:
- Expense. Patients with lower incomes can buy big jars of aspirin at discount stores and, under a doctor’s care, take as many as two dozen a day for pain relief.
- Versatility. Many people who suffer from long-term pain are older. So taking aspirin for pain also will help protect the cardiovascular system from heart attacks and strokes caused by clotting.
- It’s chewable. Aspirin can be chewed and swallowed. Or pills can be dissolved in water and consumed, a big plus for people who have trouble swallowing pills.
- It can save lives. In the event of a heart attack, chew two aspirin, and the effect of easing the effect of a blood clot is almost immediate, doctors say. No other nonprescription drug can do that.
“I tell my students to always keep a small package of aspirin,” Thekkapat says. “If you’re out somewhere or on an airplane and someone calls for medical help, this may give them a little more time to get to a hospital.”
Physicians suggest that if you have stomach problems with aspirin, either take a coated aspirin such as Ecotrin, a buffered aspirin such as Bufferin or talk to your doctor to find a painkiller that’s directed at your specific pain. Taking an antacid won’t prevent stomach problems.
Don’t take different nonsteroidal anti-inflammatory drugs at the same time, experts warn. They neutralize each other so that neither works well. And that would include aspirin’s prevention of clotting.
The remedy, experts say, is to wait several hours between taking one drug and taking the next.
Physicians and pharmacists say to separate your aspirin dose by eight to 12 hours, and you’ll get the benefit of both drugs.
“Simply take the painkiller in the morning and the aspirin in the evening,” Brasington says.
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Aspirin: Acetylsalicylic acid
Dosage: 81 milligrams a day for cardiovascular system protection; one or two pills of 325 milligrams for pain relief or one or two pills of 500 milligrams (“extra strength”) for tougher pain. Aspirin is an ingredient in many brand-name pain, cold and allergy remedies. Manufacturers couple aspirin with other drugs for its anti-inflammatory effects.
Most common uses: to relieve headache pain, rheumatoid arthritis pain or to prevent clotting.
What aspirin can do
Aspirin can ease or eliminate a headache.
Dose: Two 325 milligram tablets every four hours.
Alternative: Ibuprofen (Motrin), acetaminophen (Tylenol) or prescription headache medicines.
Aspirin can reduce joint aches caused by arthritis or overuse and ease some long-term pain.
Dose: Two 325 milligram tablets every four hours as needed. Under a doctor’s care, the amount can be more than 20 pills a day.
Alternatives: Naproxen, prescription pain remedies.
Aspirin can work for mishaps such as a twisted ankle, a bruise or bumped knee.
Dose: Two 325 milligram pills along with a cold pack to reduce inflammation.
Alternatives: Ibuprofen, ketoprofen. But people with low incomes can more readily afford aspirin.
Heart attack prevention
Aspirin can help prevent blood clots that cause heart attacks and strokes.
Dose: 81 milligrams a day.
Alternatives: Prescription drugs.
Caution: It doesn’t take much to prevent clotting, but too much aspirin can make bleeding tougher to stop. Also, don’t take aspirin if you’re taking a prescription blood thinner.
Aspirin brings down fevers by blocking the mechanism that causes body temperature to rise.
Dose: Two 325 milligram tablets every four hours until the fever breaks.
Alternatives: Ibuprofen, acetaminophen.
Caution: Aspirin is linked to Reye’s syndrome, a neurological disorder. Statistics show that 90 to 95 percent of people who develop Reye’s syndrome have taken aspirin to relieve the symptoms of a viral infection. Reye’s can be fatal. This is especially true for children, so the standard is to never give aspirin to children for an illness caused by a virus.
Chewing two aspirin during a heart attack can get your blood moving enough to get you to an emergency room.
Dose: Two generic white tablets at 325 milligrams each.
Alternatives: No other over-the-counter medicine does this.
Chewing aspirin during a stroke can relieve clotting in the brain. But a stroke also can be caused by bleeding in the brain, in which case you shouldn’t use aspirin. Check with your doctor about your risks.
Dose: If you get the OK, chew two tablets, 325 milligrams each, when you feel the symptoms. Then get to an emergency room.
Aspirin is associated with reduced cancer risks, especially for colorectal cancer. In April, the American Cancer Society published a study that said aspirin shows promise as a drug to reduce cancer risks. But medical researchers aren’t ready to tell people to take aspirin to prevent cancer.
Dose: No one knows, but if you’re taking an aspirin a day for cardiovascular protection, that could be enough. Right now, the association is based on numbers.
Copyright 2007 St. Louis Post-Dispatch, Inc.