Asprin  Salicylates  Includes-

salicylates, choline salicylate, sodium salicylates

Interacting drugs -summary

            
+ Aspirin
Alcohol  + Aspirin

Risk of GI ulceration increases when salicylates are given concomittantly
Ingestion of alcohol during salicylate therapy may prolong bleeding

ACE inhibitors + Aspirin

Antihypertensive effectiveness of these agents  may be decreased  by
concurrent salicylate admin. possobly due to prostagladin inhibition.

Anticoagulant oral  + Asprin

Therapeutic aspirin has an additive hypoprothrombinenic effect.Impaired
platelet time and bleeding time. Use caution

Betablockers + Aspirin

May have their antihypertensive action blunted by concurrent salicylate
 admin.  Consider discontinuing salicylates if problems occur.

Heparin    + Aspirin 

Aspirin can increase bleeding risk in heparin coagulated patients

Loop diuretics + Aspirin

May be less effective when given to with salicylates to patients

Methotrexate  + Aspirin

Salicylates increase drug levels causing toxicity by interfering with proteins

Nitroglycerin + Aspirin

When taken with aspirin, may result in unexpected hypotension. If occurs
 reduce nitroglycerin dose

NSAIDs + aspirin

May decrease NSAID  serum conc. concomittant use offers no advantage

Probenecid, sulfinpyrazone  + aspirin

Salicylate antagonise the uricosuric  effects.

Vaproic acid   + Aspirin

Aspirin displaces drug from its protein binding sites and may decrease
 total body clearance

 .

Prevention of secondary thrombolotic cerebro-vascular or cardiovascular disease.

Asprin/Salicylates  Include-

Salicylates, choline salicylate, sodium salicylates

Most common- Salicylates - Nausea, dyspepsia ( 5% to 25% )

GI- Nausea, dyspepsia ,heartburn, epigastric discomfort, anorexia, acute reversible hepatotoxicity, massive GI bleeding, and occult blood loss may occur.

Aspirin may potentiate peptic ulcer.

Chronic aspirin use may cause a persistent iron deficiency anemia

Dermatologic- hives, rashes, and angioedema may occur, especially in patients suffering from chronic urticaria

Hepatic- hogh aspirin doses reportedly produced reversible hepatic dysfunction

Hematologic- prolongation of bleeding time, leucopenia, thrombocytopenia, purpura,decreased  plasma concentration, shortened erythrocyte survival time 

Miscellaneous- fever, thirst, dimness of vision

Allergic Anaphylactic reactions-  noted when hypersensitive individuals took aspirin. Fatal anaphylactic shock, while not most common, has been reported

Aspirin intolerance - manifested by excaberation of bronchospasm and rehinitis,may occur in patients with a history of nasal polyps, asthma, or rhinitis

Reyes syndrome in children,overdose.

Ketosis,acidosis,hyperventilation,nausea,vomiting,

dyspepsea gastric bleeding and ulceration,tinnitus,

dizziness, deafness(temporary), sweating, hypersens esp in asthmatics,

increased bleeding time

Hepatotoxicity and nephropathy with long term large doses.

Active GI tract ulceration,hypersens,hypoprothrominemia.

Special precautions:

H/o ulcer,dyspepsia,children below 12 yrs,bleeding disorders.

Date of Approval -     2003

Indication-

Prevention of secondary thrombolotic cerebro-vascular or cardiovascular disease

Dosage-

50- 100mg once daily

Aspirin-    Analgesics & Antipyretics

EVIDENCE BASED MEDICINE (MIMS April 2003)

                          Stroke prevention

Comparative effectiveness of various interventions

PRIOR TO STROKE OR TRANSIENT ISCHAEMIC ACCIDENT (TIA)

Beneficial

1. Antiplatelet treatment

2. Cholestrerol reduction (for those patients who also have coronary heart disease)

3. Carotid endarterectomy (in patients with severe symptomatic carotid artery stenosis)

Unknown effectiveness

1. Cholesterol reduction (for patients without CHD)

2. Blood pressure reduction

3. Carotid endarterectomy (in patients with severe symptomatic carotid artery stenosis)

4. Catotid angioplasty Likely to ineffective or even harmful

ATRIAL FIBRILLATION AND A PRIOR STROKE OR TIA

Beneficial.

1.Oral antocoagulation

2. Aspirin for patients with contraindications to an anticoagulant

ATRIAL FIBRILLATION BUT NO OTHER MAJOR RISK FACTORS FOR STROKE

 KEY POINTS

In patients with a prior stroke or TIA

1. Insufficient evidence to support routine blood presure reduction

2. Statins may prevent stroke in those with a history of CHD but evidence inconclusive in those with no history of CHD.

3. Routine use of prolonged anti-platelet treatment beneficial ( if no contraindication)

4. Aspirin 75mg daily as effective as higher doses. No evidence that any other antiplatelet regimen is definitely superior in the prevention of vascular events. Clopidogrel or the combination of asprin and dipyridamole are safe and effective (but more costly) alternatives to aspirin.

5. No evidence of benefit from anti-coagulation in patients in sinus rhythm, but an increased risk of serious bleeding.

6. Carotid endarterectomy reduces risk of major stroke in patients with severe carotid stenosis provided the risks of imaging and surgery are small.

7. Percutaneous transluminal angioplastys role has not been evaluated adequately.

In patients with atrial fibrillation and a pror stroke or TIA

1. Anticoagulants reduce risk of stroke, provided there is low risk of bleeding and careful monitoring

2. Aspirin reduces risk of stroke but less effectively than anticoagulants. These findings support the use of aspirin among patients with atrial fibrillation and contra-indication to anticoagulants.

In patients with atrial fibrillation but neither major risk factors for stroke

1. Anticoagulants are of net benefit, if low risk of bleeding and careful monitoring

2. Aspirin is a reasonable alternative in patients with contra-indications to anticoagulants

Urticaria 

Drugs causing adverse reactions-

1. Aspirin

2. Penicillin

3. Sulfonamides

4. Barbiturates

Asprin  Salicylates  Includes-

salicylates, choline salicylate, sodium salicylates

REFER - ASPIRIN

1.May cause GI upset,take with food or after meals.

2.Do not crush or chew sustained release preparations.

3.Take with a full glass of water(240ml) to reduce the risk of lodging medication in the oesophagus.

4.Patients allergic to tartarazine should avoid aspirin.

5.Notify physician,if ringing in the ears or persistent GI pain occurs.

6.Do not use aspirin if it has a vinegar-lke odour.

7. Allergy- tell your doctor if yu are allergic to aspirin or other salcylates including methylsalicylate or any of the following- Diclofenac Difunisal Etodalac Fenoprofen Floctafenine Flurbiprofen Ibuprofen Indomethicin Ketoprofen Ketorolac Meclofenamate Mefenemic acid Nabumetone Naproxen Oxaprozin Oxyphenbutazone Phenylbutazone Piroxicam Sulindac Tenoxicam Tiaprofenic acid Tolmentin Zomepirac .

8. Diet- Make sure your doctor knows if you are on a low sodium diet. Regular use of large amounts of sodium salicylate can add a large amount of sodium to your diet.

9. Pregnancy- Have not been shown to cause birth defects in humans. Studies on birth defects have been done on aspirin but not other salicylates. However, salicylates caused birth defects on animal studies

10. Breast feeding- Salicylates pass into breast milk. Although salicylates have not been reported to cause problems in nursing babies, it is possible that problems may occur if large amounts are taken regularly as for arthiritis

11. Children- Do not give aspirin or other salicylates to a child or a teenager with fever or other symptoms of virus infection. especially for chicken pox, without first discussing with your childs doctor.

12. Older adults- Elderly people are more sensitive to effects of salicylates. This may increase the chance of side effects during treatment.

13. Other medicines- Tell your doctor if you are taking any other medicines- Anticougulants or Carbencicillin or Cefamandole or Cefotetan or Dipyridamole or Divalproex or Heparin or Infalmmation or pain medicine , except narcotics or Pentoxyfylline or Plicamycin or Tilcarcillin or Valproic acid -taking these medicines together with salicylate especially aspirin, may increase chance of bleeding

 .

14. Other medical problems- Your doctor may wish to know if you having any of the following- Anemia or Overactive thyroid or Stomach ulcer -salicylates may make conditions worse.

15. Dosing- Follow your doctors instructions

16. Missed dose- If you miss a dose of this medicine take it as soon as possible. However, it is almost time for the next dose, skip the missed dose and go back to normal schedule. Do not double doses.

17. Storage- Keep the medicines our of reach of children Store the medicines away heat and direct light Do not store tablets or capsules in the bath room, in damp places near the kitchen sink

Heat and dampness cause the medicines to break down Store asprin suppositories in a cool place, but keep it from freezing

Do not store out dated medicines or medicines no longer needed. Make sure that all discared medicines are kept out of reach of children

Pharmacolgy:

Salicylates have analgesic,antipyretic,anti-inflammatory and anti-rheumatic effects. Salicylates lower elevated body temperature through vasodilation of peripheral vessels,thus enhancing dissipation of excess heat. The anti-inflammatory and analgesic activity may be medicated through inhibition of prostaglandin synthetase enzyme comples.

Pharmacokinetics:

Salicylates are rapidly and completely absorbed after oral use. Bioavailabilty is dependent on the dosage form,presence of food,gastric emptying time,gastric pH,presence of antacids or buffering agents and particle size. Bioavailability of enteric coated tablets may be erratic.

Take with food
 

Pregnancy:

Avoid use during pregnancy especially in third trimester.

Lactation:

Salicylates are excreted in breast milk in low concentrations. Advese effects on platelet function in the nursing infant have not been reported, but are are a potential risk.

Children:

Administration of aspirin to children (including teenagers) with acute febrile illness has been associated with the development of of Reye's syndrome.