Aspirin - Still a "Miracle Drug" - but Caution Required!

Introduction

Aspirin is one of the most common nonprescription drugs in America. Many people take it for arthritis. Others take it to help prevent heart attack and stroke. It is still a "miracle drug" in its ability to fight pain and inflammation -- and even more amazing in its ability to reduce heart attack and stroke risk. Most people think it's pretty safe.

Most people know about the most common problems with aspirin: stomach irritation/ulcers. Some are aware of the risk of significant aspirin allergy. In some cases, these reactions can be killers. Another potentially deadly problem is salicylism - aspirin poisoning - and most people don't know about it.

Even with all the new anti-inflammatory drugs available, aspirin still has a place in many of our medicine cabinets. But we need to know the risks.

Stomach Irritation and Ulcers

Aspirin can irritate the lining of the stomach. This can cause heartburn, nausea, and vomiting. Sometimes, aspirin can cause ulcers - which are small erosions in the stomach or intestines. If painful symptoms are ignored, catastrophic internal bleeding can occur. Rarely, such bleeding can happen even without symptoms.
You don't have to take big doses to get ulcers. In some people, even one aspirin a day over a long period can cause ulcers. Although it's a risk that may well be worth taking, you need to discuss with your doctor the risks and benefits for you personally.

The people who are at greatest risk of ulcers and bleeding:

• drink alcohol every day;
• are over 60;
• have had ulcers;
• take cortisone drugs, such as prednisone;
• take other non-steroidal anti-inflammatory drugs (NSAIDs) - whether prescription or over the counter.

If you take aspirin plus an NSAID -- such as naproxen (Naprosyn) or ibuprofen (Motrin, Advil and others), or even a COX-2 inhibitor - such as celecoxib (Celebrex) - your increase your risk of an ulcer. Some people taking aspirin and an NSAID may need also to take medication to protect them from ulcer.

Aspirin Allergy

Allergic problems may arise the first time you take aspirin. Or allergy may hit suddenly after you have been taking aspirin without problems for many years. It even can hit after age 60.

Most commonly, aspirin-allergic people develop rashes. These may range from dermatitis (inflamed skin) around the lips to urticaria (hives). In the worst case, they can develop angioedema - hive-like swelling inside the windpipe that can block breathing. If you develop a rash after taking aspirin, call your doctor for advice. If you develop hives or start to feel your neck swelling or have trouble breathing, call an ambulance.

Or aspirin allergy may influence the development of asthma. If you feel wheezy after taking aspirin, talk with your doctor. The outlook for asthma patients allergic to aspirin is the same as for asthma patients who are not sensitive to aspirin.

Some people who are allergic to aspirin are allergic to all NSAIDs - such as ibuprofen (Motrin, Advil, and others). There is still controversy as to whether this allergy will also happen after taking a COX-2 inhibitor, such as celecoxib (Celebrex). So caution is needed with those drugs as well if you have had an allergic reaction to aspirin.

Aspirin Poisoning

Salicylism is the name for aspirin poisoning. It usually happens through accidental overdosing. Typically, you're taking normal doses of aspirin - while also taking drugs that you don't realize contain aspirin.

Chronic salicylism is common in adults who:

• often self-treat with aspirin or other over-the-counter drugs for arthritis, general aches and pains, and/or stomach upset;
• frequently take multiple medications;
• take high doses of vitamin C;
• are taking penicillin;
• have reduced liver and kidney function.

As you age, your kidneys and liver may not work as well as when you were younger. That damages the body's ability to use and dispose of drugs properly.

The first warning sign of aspirin poisoning is usually ringing in the ears and decreased hearing. That's a sign to cut back on aspirin right away and call your doctor. Other early signs may include dizziness, headaches, and confusion or disorientation. If diagnosed early, just halting aspirin may be all that's necessary to get you back to normal. But it may take a few days for your body to completely get rid of the excess.

More severe salicylism causes nausea, vomiting, diarrhea, fever, headache, severe thirst, irritability, small purplish skin spots, profuse sweating, convulsions, even coma. Getting medical help is urgent.

But getting the right help may be challenging. Most of these symptoms can easily mislead doctors. They may hunt for a major disease while you get worse. So be sure to tell the doctor about all drugs you have taken in the last few days - both prescription and over-the-counter. And if you think aspirin might be the culprit, speak up.

Finding Aspirin in Unexpected Products

Sometimes you're taking aspirin without even realizing it. Aspirin is in many over-the-counter drugs. These include Alka-Seltzer, Anacin, some types of Excedrin, even Pepto Bismol - plus plenty of others. You have to read labels carefully, looking for "aspirin" or its chemical names: "salicylic acid" or "acetylsalicylic acid."

Some herbs and spices contain salicylates, such as curry powder, paprika, thyme, garam masala, and rosemary. Some teas have high levels too - as well as licorice, peppermint candies, and some honeys.

You may even be getting aspirin in some topical creams, such as one health food store product containing trolamin salicylate - or bath salts containing white willow. Gradually - or quickly - it can all add up.

So prevention is important. Know what's in every drug you take. Remember, some products from the health food store also may contain aspirin - or aspirin "cousins" such as white willow bark. Read those labels. Always keep a list in your wallet of all drugs you are taking - for emergencies. Report any unusual symptoms to your doctor promptly.

Aspirin Benefits

Of course, aspirin is not all bad. In fact, it can be excellent and useful for some problems. Occasional aspirin for headaches or joint pain or achiness is a good example.

Daily doses of baby aspirin are often recommended by doctors for people who have had heart attacks or who are at increased risk of heart attacks.

Many physicians advise a baby aspirin once a day for men over 50 and women over 60 - just because of the increased risk of heart disease and stroke as we get older. That's because aspirin helps prevent blood clots - a major factor in heart attacks. Research is also exploring other potential benefits of aspirin.

But you should never take daily aspirin without consulting with your doctor - and not only because of the problems discussed above. Aspirin may cause problems with other drugs you take. Sometimes aspirin worsens their risks - or decreases their effectiveness. Or it can work in reverse: other drugs may worsen aspirin's risks or decrease its effectiveness. Or aspirin may increase the risk of other drugs.

For example, since aspirin has a blood-thinning effect, adding it to an anticoagulant such as warfarin (Coumadin) -- which thins the blood in a different way from aspirin -- can cause abnormal bleeding.

For children, aspirin use for fever has been associated with an increased risk of Reye's Syndrome. That's a life-threatening problem. Therefore, when children have fever, it's better to give them acetaminophen (Tylenol or Panadol).

If you are taking aspirin for heart attack or stroke protection, you need to know the latest research. It suggests that adding ibuprofen may reduce the benefit of the aspirin. So it's important to tell your doctor which over-the-counter medications and supplements you are taking.

Indeed, if you're taking anything other than an occasional aspirin, talk to your doctor about it. If you need a lot of aspirin to control your arthritis pain, your doctor may recommend something else -- or decide to give you medication to protect you from ulcer. Each person has a different level of risk of complications, such as ulcer. Only doctor can assess your level of risk.

Americans are still using a lot of aspirin. Its heart attack and stroke prevention benefits suggest we will be using it for a long time to come. We need to be "educated consumers" and appreciate the risks that can come even from "old friends" - like aspirin and other "over-the-counter" remedies.