SALICYLATES AND NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS)

The salicylates are used to relieve pain and to reduce fever and inflammation. Aspirin,  a non-steroidal anti-inflammatory drug (NSAID), is the most well-known and frequently used salicylate. Other salicylates discussed on this website are salsalate and magnesium salicylates.

Aspirin

Aspirin is the common name for a chemical called acetylsalicylic acid, or ASA (as it is still known in Canada and some other countries). Aspirin, used as directed, is perhaps the most effective non-narcotic remedy, prescription or nonprescription, for pain, fever, and inflammation. Unfortunately, certain people should not use aspirin.

Aspirin Allergies

Some people are allergic to aspirin and may experience a wide variety of reactions, including hives, rash, swollen lymph nodes, generalized swelling, severe breathing difficulties, or a drop in blood pressure. Simple stomach discomfort following the use of aspirin or any other medication, however, does not indicate that you have an allergy.

Asthmatics seem to be particularly prone to aspirin allergies, as well as allergies to calcium carbaspirin, another member of the salicylate family.

If you have ever had an allergic reaction to aspirin or any other drug, be sure to tell your doctor. This kind of reaction can also occur in response to other related medications, which include prescription drugs containing salicylates or similar ingredients.

Aspirin and the Digestive Tract

Aspirin is a locally irritating, corrosive substance, which when used for a long time or in high doses can increase the likelihood of developing peptic ulcers (in the lower part of the esophagus, the stomach, or the beginning of the small intestine). If you have ulcers, inflammation of the stomach (gastritis), or any form of stomach discomfort, you should not be taking even small quantities of aspirin, in any form.

Aspirin and Bleeding

Aspirin causes bleeding in the stomach; over time, it can weaken the body’s ability to slow and contain bleeding. Taking aspirin for a few days can increase the amount of bleeding during childbirth, after tooth extraction, and during surgery. Aspirin should not be taken for at least five days before surgery, even in small doses. Persons with serious liver disease, vitamin K deficiency, or blood clotting disorders, or persons already taking blood thinners (anticoagulants, such as warfarin and heparin) or other drugs, should not take aspirin without strict supervision of a doctor or other health professional.

Aspirin should not be taken in very large doses (more than 12 regular-strength 325 milligram or five-grain tablets per day) or for more than a few days without the supervision of a doctor. Even small doses used over a long period of time may leave certain predisposed individuals at an increased risk of serious bleeding after wounds or cuts.

Aspirin Preparations and Use

Aspirin is highly advertised, and there are many different brands from which to choose. We recommend plain generic aspirin for intermittent use, such as for an occasional headache.

There are several forms of aspirin available. These are plain aspirin, enteric-coated aspirin, and buffered aspirin. In previous editions of Worst Pills, Best Pills, we recommended the use of enteric-coated aspirin over plain or buffered aspirin because enteric coating was once thought to reduce the overall risk of GI bleeding, as this form of aspirin does not dissolve in the stomach. The weight of the evidence now indicates that the risk of GI bleeding is similar among plain, enteric-coated, and buffered aspirin,[1],[2],[3],[4] probably because, in part, once aspirin is absorbed into the blood it can cause GI bleeding not related to local irritation but due to its effects on diminishing the natural protection of the GI tract and blood clotting.

Enteric-coated aspirin should not be used for occasional problems, such as headaches, because it is absorbed more slowly than regular aspirin and takes more time to relieve pain.

Alka-Seltzer contains aspirin and buffering agents and is much less irritating to the stomach than regular or buffered aspirin, but it is quite expensive and contains a great deal of salt (sodium).[5] If you have to restrict your intake of salt or take a salicylate for a long time, do not use Alka-Seltzer. Since this drug contains aspirin, do not use it as an antacid.

Taking aspirin with food or after meals can decrease stomach upset. If you are on a high-dose salicylate treatment together with antacids, do not suddenly change (start or stop) the way that you take antacids without talking to your doctor first.

If you take aspirin or another salicylate regularly, the level of drug in your blood may have to be checked to make sure that you are taking the best dose. You should also have regular checkups and ask your doctor about the necessity of certain tests including hematocrit (a blood test), kidney and liver function tests, and hearing tests. Also ask if you should take vitamin C or vitamin K.

Salicylates should not be used by anyone with acute liver or kidney failure. They should be discontinued by anyone who has chronic liver or kidney disease if there is any sign of a worsening condition.[6] If you develop ringing in your ears or persistent stomach pain after using aspirin for a long time, call your doctor.

When you buy aspirin, make sure it is pure white and does not contain broken tablets. If it smells like vinegar, do not use it. Do not store your drug in the bathroom medicine cabinet because the heat or moisture might cause it to deteriorate and lose its effectiveness. Keep it away from heat and direct light.

This warning appears on this web site in the profiles of drugs that contain aspirin and other salicylates. Although most cases of Reye’s syndrome are in children, some occur up to age 40. People under 40 who have chicken pox, flu, or flulike illness and need a drug simply to relieve pain or reduce fever should use acetaminophen (TYLENOL, for example) rather than aspirin.

Gastrointestinal (GI) bleeding and perforation are common and serious adverse effects of NSAIDs. These adverse reactions can lead to hospitalization and potentially death. About one-third of all bleeding ulcers in older adults are linked with this family of drugs. The most important factors predisposing people to GI toxicity from NSAIDs are the type and dose of drug (and use of two NSAIDs together), which can increase the risk up to 20-fold. Other risk factors include a history of ulcer, anticoagulants (blood thinners), steroid drugs, smoking, alcohol use, and older age.[7]

An ingenious study published in 1996 involving patients who had bled while taking an NSAID supports a principle long held by Public Citizen’s Health Research Group: patients who are informed about the risks of their drugs and instructed what to do if an adverse reaction should occur can avoid serious drug-induced injury.[8]

In the study, patients who had experienced GI bleeding and were subsequently hospitalized knew less about the adverse effects of NSAIDs or what to do when they occurred than those using these drugs that did not have GI bleeding. Fewer patients who bled (16%) than those that did not (41%) remembered having been told of the potential adverse effects of NSAIDs or about what steps to take if they developed an adverse effect (4% versus 21%). Faithful obedience (compliance) in taking an NSAID was more common in patients who bled (96%) than in those who did not (70%). In addition, 18 (36%) of those who bled had experienced stomach pain before bleeding and all but two had continued to take the drug, while only 15 (15%) of those who did not bleed had stomach pain, of whom 10 had subsequently reduced their intake of the NSAID.