THE
PEOPLE’S
PHARMACY
Graedons’ Guide to
Key Aspirin Information
spirin is truly a miracle. No
other medicine does so much for
so many at so low a price. Every
single day in the U.S. 80 million
aspirin tablets are swallowed. At a
time when many medicines now cost a
dollar or more per pill, aspirin is still
the best bargain in town at less than
one cent a tablet.
A
Americans down
29,200,000,000
doses of aspirin
each year. That
equals 117 pills for
every man, woman
and child.
V ERSATILITY
s
People take aspirin for everything
from aches and pains to strains and
sprains. It is still considered the gold
standard when it comes to arthritis.
Most garden-variety headaches respond
well to aspirin and new data suggests
that one tablet taken every other day
may even help prevent some migraine
attacks. Researchers have been
impressed with this drug's ability to
reduce the risk of heart attacks and
strokes. Now preliminary data suggest
it may also help lower the chances of
colorectal cancer.
PROPER STORAGE
The medicine chest is the worst
place in your house to store aspirin.
Heat and humidity are enemies of all
drugs, especially acetylsalicylic acid.
Child-proof caps may not be airtight.
Always remove the cotton from
your aspirin bottle since it serves
absolutely no purpose once you've
bought it. The only reason this filler
is there in the first place is to stabilize the pills during shipping so they
don't crumble. Cotton can absorb
moisture and make aspirin deteriorate more quickly.
You may be able to tell if aspirin is
going bad by smelling the open
bottle. A vinegar-like odor signals
acetic acid, a breakdown product of
aspirin. This is not dangerous, but it
could signal that your aspirin is
beginning to lose its punch. Even if
you are within the expiration date,
you may want to replace aspirin that
smells.
POPULAR ASPIRIN MYTHS
1) Aspirin applied directly to a toothache can relieve the pain.
Don‘t use aspirin directly on a toothache; it’s far too irritating to the gum tissue and can do damage to the
tooth. Of course you can swallow two aspirins to ease minor pain.
2) Aspirin gum can ease pain from a sore throat.
Aspirin does not provide a local soothing effect. The only benefit from aspirin gum depends on how much
aspirin you swallow, how much gets into your stomach and ultimately circulates through your blood stream.
That is a roundabout way to get aspirin to ease a sore throat. Swallow two pills and gargle with salt water
instead.
3) An aspirin in a vase of cut flowers will make them last longer.
Aspirin does not appear to prevent flowers from deteriorating or stimulate plant growth. Save the aspirin for
aches and pains, strains and sprains.
4) Combine aspirin with Coca Cola and you can get high.
We don't know how this story got started, but there is no way you can get high on aspirin and Coke. Once
upon a time there was a small amount of cocaine in Coca Cola, but not enough to get “high.” Caffeine in
Coke might boost the pain relieving power of aspirin.
© 1993
Graedon Enterprises
D OSAGE
Have you ever wondered why aspirin
is often labeled “5 gr.”? Although it is
rare to find old-fashioned apothecary
measurements like grains, drams and
minims on most medicines these days,
aspirin is still measured in an outmoded dose.
When this drug was developed
almost 100 years ago, the usual
recommendation was 10 grains, which
translates into our modern measurement of 648 milligrams. That means
each tablet should be 324 mg--a rather
unusual dose, to say the least. Most
manufacturers actually put 325 mg in
their regular-strength aspirin tablets
so the label won't look too peculiar,
but there is nothing sacred about the
standard 5 grain dose.
Children's aspirin
for adults?
ST. JOSEPH
CHEWABLE ASPIRIN
Low Strengh Caplets
(81 mg each)
It may be hard to find
baby aspirin these days
because of a fear of
Reye's syndrome, but the
maker of St. Joseph
brands now has a “baby
strength” specifically for
adults.
2
Garden-variety pain
How much aspirin should people
take? The standard recommendation,
“take two tablets every four hours,”
probably dates back to the time of
aspirin's 5 gr. dose, but for regular
headaches, minor pains or fever, it
still holds for most people.
Now, a 95-pound grandmother may
find that one and a half tablets works
fine, whereas a lumberjack who
weighs in at 285 pounds may need
three. Manufacturers have long
fiddled with the dose so that they
could make marketing claims. For
example, the makers of Anacin
advertised for years that their product
contained more pain reliever than any
of the other leading brands. Big deal!
They have 400 mg of aspirin in each
tablet instead of 325 mg. If you truly
need this “extra strength” you could
accomplish virtually the same thing by
taking two and a half regular-strength
generic tablets.
Other manufacturers have come up
with their own dosing strategy. For
example, Maximum Bayer Aspirin
Tablets each contain 500 mg. Boots
Pharmaceuticals markets a prescription controlled-release aspirin product
called ZORprin which has 800 mg,
while Parke-Davis makes Easprin, a
prescription-only coated aspirin with
975 mg per tablet.
I nflammation
If you are using aspirin for something other than pain relief, the
“right” dose may be quite different
from the standard two-every-fourhours. The anti-inflammatory action of
aspirin only kicks in at higher levels.
For people with arthritis, the recommended dose ranges from 3,600 mg to
5,400 mg a day. That translates to
anywhere from about a dozen to 16 or
so standard tablets daily.
Heart attacks/Strokes
When it comes to the anti-clotting
aspects of aspirin, a much lower dose
is appropriate. We're talking about
preventing heart attacks, strokes and
perhaps even migraine headaches.
Researchers wonder how low you can
go and still measure a therapeutic
benefit. The results are truly astounding.
Over 22,000 doctors were recruited to
serve as guinea pigs in the largest
aspirin study to date. Half received
one regular-strength aspirin tablet
every other day. The other group took
an inactive placebo. This Physicians’
Health Study showed that healthy
men taking low-dose aspirin therapy
had 44 percent fewer heart attacks.
A follow-up analysis demonstrated
even more impressive results for those
physicians at high risk of heart attack.
The same aspirin dose reduced the
risk of heart attack by 87 percent for
those men with chronic chest pain
(stable angina).
Not only did aspirin lower the chance
of heart attack, it also appeared to
reduce the frequency of migraine
headaches. Doctors on aspirin in the
Physicians’ Health Study had 20
percent fewer migraines than those on
placebo. British research supports this
finding. Dr. Richard Peto has reported
that in a similar study, British doctors
experienced almost 30 percent fewer
migraines. He suggests, “A migraine
patient should consider taking a baby
aspirin a day.”
It is hard for most people to believe
that such a low dose (one-fourth of a
regular tablet) could do much of
anything. Certainly no one would
PROTECTING YOUR STOMACH FROM
ASPIRIN DAMAGE
Stomach irritation from aspirin is both direct and indirect. Counteracting the
immediate effect of aspirin in the stomach with food, antacids, buffered
brands or coated products such as Ecotrin, Easprin, or Therapy Bayer
Caplets may help a little with indigestion and heartburn. But aspirin also
lowers body-wide levels of hormone-like chemicals (prostaglandins). Prostaglandins protect the stomach lining from ulcers and bleeding, so when
aspirin reduces their action, irritation and blood loss is common.
Salsalate (Disalcid, Salflex) and choline magnesium trisalicylate (Trilisate)
are aspirin-like drugs that may be a little easier on the digestive tract. They
work well against inflammation but may not relieve pain as well as aspirin.
Carafate (sucralfate) or Cytotec (misoprostol) are sometimes prescribed to
counteract stomach irritation. Carafate is well tolerated, but Cytotec can
cause severe diarrhea, stomach pain, nausea, gas and headache.
expect it to relieve a normal headache,
let alone a migraine. But low doses of
aspirin apparently prevent blood
platelets from sticking to each other
and forming a clot. Scientists now
think that such spontaneous clots may
play a role in triggering heart attacks
and one type of stroke. Clumps of
platelets also seem to give off serotonin, a brain chemical that is important
in the initial stage of migraines. This
may explain how it helps cut migraine
attacks.
Doctors are still trying to determine
the optimum aspirin dose for heart
attack and stroke prevention. Swedish
and Dutch data suggest that mini
doses are as effective as larger doses
and reduce side effects. They found
that as little as 30 to 75 mg (one
twentieth to one eighth of a standard
dose) worked against blood clots. No
one should ever start a life-long
aspirin regimen without first consulting with a physician about the appropriate dose and possible risks.
SIDE EFFECTS
Despite such impressive benefits,
aspirin poses a number of risks.
Stomach irritation is very common,
even at relatively low doses. Stomach
bleeding and ulcers can be a real
hazard, especially for older people who
must take larger amounts for arthritis. Ringing in the ears (tinnitis),
dizziness or hearing loss can also
occur at high doses and require
prompt medical attention. People who
are allergic to aspirin-like drugs can
develop nasal growths (polyps) and
such people are more likely to suffer
from aspirin-induced asthma.
Another serious complication from
regular aspirin use is bleeding. Because the platelets become less
“sticky,” people may bruise easily or
even hemorrhage. If this were to occur
in the brain, it could lead to a bleeding
stroke. Although this complication is
relatively rare, people with a bleeding
tendency or uncontrolled high blood
pressure should not be taking aspirin
except under a physician’s supervision.
For all these reasons aspirin should
never be taken for granted, especially
if you are on other medications.
Aspirin can interact with dozens of
other over-the-counter and prescription drugs. Some of these combinations can be life-threatening.
Reye's
Syndrome
This is a rare but very
dangerous condition that
may occur in children,
from babies to teenagers,
following a viral infection
such as influenza or
chicken pox. Since it is
often hard to know if your
child has the flu, be
extremely cautious when
it comes to administering
aspirin in any form. That
includes Pepto-Bismol,
which contains bismuth
subsalicylate, an aspirinlike ingredient.
Symptoms of Reye's
syndrome include nausea, vomiting, irritability,
lethargy, disorientation,
and in severe cases,
coma.
DRUG INTERACTIONS
Because aspirin doesn't require a
prescription and may be taken on a
daily basis, there may be a temptation
to take this drug for granted. That
could be tragic. Aspirin can interact
with a number of other medications.
Coumadin (warfarin), for example, is
a blood thinner that could cause lifethreatening hemorrhage in combination with aspirin. New research shows
that aspirin can reduce the effectiveness of Vasotec (enalapril) for controlling heart failure.
Always check with your physician
and pharmacist before taking aspirin
together with other medications.
3
DRUG
Activated
AcDRUG
Charcoal
Alcohol
INTERACTS WITH ASPIRIN:
Activated charcoal, sometimes taken for flatulence, can attach to many
other drugs, aspirin among them. It may reduce aspirin’s effectiveness.
Taking aspirin together with an alcoholic drink could easily aggravate
stomach irritation. There is also a possibility that blood alcohol levels
might end up higher than expected after just one and a half drinks if
aspirin were taken an hour beforehand. There is disagreement about the
clinical and legal implications of this interaction, but why not avoid it?
Antacids
Advanced Formula Di-Gel
Gelusil
Maalox
Milk of Magnesia
Tums, etc.
Anticoagulants
Coumadin (warfarin)
Dicumarol
Heparin
Miradon (anisindione)
Arthritis
Because aspirin also has anticlotting action, any of these prescription
blood thinners (including heparin) might work too well in combination
with aspirin. The potential exists for dangerous excessive bleeding.
Careful monitoring is crucial.
Drugs
Advil (ibuprofen)
Clinoril (sulindac)
Feldene (piroxicam)
Motrin (ibuprofen)
Naprosyn (naproxen)
Voltaren (diclofenac), etc.
Ascorbic Acid
Vitamin C
Baking
Using antacids regularly can reduce the amount of aspirin circulating in
the body. People using anti-inflammatory doses of aspirin should be
monitored if they start or stop taking antacids daily.
Soda
Although this interaction is not well established, some people find that
these drugs for arthritis, bursitis, tendinitis, and other problems are less
effective in combination with aspirin. In addition, stomach irritation may
become worse.
People who take aspirin on a regular basis may have lower levels of this
vitamin inside certain cells. It’s not clear, though, whether there are any
medically significant consequences. The interaction between aspirin and
vitamin C is complicated and seems to differ with dietary levels of the
vitamin. In one study, aspirin reduced urinary excretion of ascorbic acid
when the vitamin was in ample supply; paradoxically, when dietary levels
were low, aspirin led to greater excretion of vitamin C.
This home remedy for indigestion could make urine alkaline. The result
would be more rapid elimination of aspirin from the system.
Beta Blockers
Blocadren (timolol)
Corgard (nadolol)
Cartrol (carteolol)
Inderal (propranolol)
Lopressor (metoprolol)
Sectral (acebutolol)
Tenormin (atenolol)
Visken (pindolol), etc.
4
These medicines used to treat high blood pressure and heart disease may
not work as effectively in the presence of aspirin. Research on this issue is
not solid, but if you must take aspirin as well as one of the beta-blockers,
you and your doctor should monitor your blood pressure response carefully.
DRUG
Capoten (captopril)
INTERACTS WITH ASPIRIN:
In theory, aspirin might interfere with the effectiveness of this blood
pressure medicine, but a small study did not turn up any problem. Monitor your blood pressure if you must take both drugs. See Vasotec for a
similar interaction.
Cortisone-like drugs
Cortef (hydrocortisone)
Decadron (dexamethasone)
Deltasone (prednisolone)
Medrol (methylprednisolone)
Aspirin is eliminated more rapidly in the presence of these strong prescription steroids. Physicians should monitor dosing carefully.
Diabetes Drugs
DiaBeta (glyburide)
Diabinese (chlorpropamide)
Glucotrol (glipizide)
Micronase (glyburide), etc.
Insulin
Diuretics
Bumex (bumetanide)
Edecrin (ethacrynic acid)
Lasix (furosemide)
Epilepsy Drugs
Depakene (valproic acid)
Dilantin (phenytoin)
Glaucoma
Aspirin can counteract the effectiveness of these strong “loop” diuretics in
people with kidney or liver problems, especially if there is fluid build-up
in the abdomen (ascites). This could have serious consequences; consult
the physician.
These important anticonvulsant drugs could become more toxic in the
presence of aspirin. A person who must take aspirin should be monitored
closely for adverse reactions and blood levels of these medicines.
Drugs
Daranide
(dichlorphenamide)
Diamox (acetazolamide)
Neptazane
(methazolamide)
Gout Medicine
Anturane (sulfinpyrazone)
Benemid (probenecid)
Methotrexate
Folex
Mexate
Rheumatrex, etc.
Vasotec
Type-II diabetics should take aspirin only under a doctor’s supervision,
with careful blood sugar monitoring. Otherwise, blood glucose might drop
too low unexpectedly.
(enalapril)
(For more details on this interaction
see: Hall, D., et al. “Counteraction of
the Vasodilator Effects of Enalapril by
Aspirin in Severe Heart Failure.” J.
Am. Coll. Cardiol. 1992; 20:15491555.)
Aspirin might increase blood levels of these glaucoma medicines to potentially toxic amounts. Elderly patients and people with kidney trouble are
at particular risk. Check with your ophthalmologist before adding aspirin.
Taking aspirin with either of these gout medicines may keep them from
controlling the uric acid build-up. In addition, aspirin won’t be able to
work against gout either. It takes no more than 700 mg of aspirin to block
Anturane almost totally.
This medication, used to treat psoriasis, rheumatoid arthritis and cancer,
could reach surprisingly high levels in the body when combined with
aspirin. This is a double-edged action, potentially increasing the power of
the drug, but also its toxicity. Don’t take any chances. Check with your
doctor before taking any aspirin while you are also taking methotrexate.
A small controlled trial (18 patients) showed that aspirin taken with or
before Vasotec blunts its beneficial effect in heart failure. There are also
a few case reports of Vasotec failing to control blood pressure as effectively when taken together with aspirin. Talk to your doctor.
5
ARE BRAND NAMES BETTER?
People often tell us that they can
only get adequate pain relief from one
particular kind of aspirin. Some folks
swear by the Bayer brand while
others love Empirin or Ascriptin.
Many insist that the only effective
headache remedy for them is AlkaSeltzer.
All we can say is that aspirin is
aspirin is acetylsalicylic acid. There is
no chemical or biological reason for
one brand to be stronger or more
effective as long as the dose is roughly
equivalent. Experts for Consumers
Union tested a number of different
brands ranging from cheap house
brands to expensive, highly promoted
products. They found no significant
differences.
But people continue to pay five to ten
times more for their favorite brand.
Why? British researchers may have
come up with an answer. In their
study an inactive placebo pill was
made to resemble a familiar brand
name aspirin product. It relieved
many people's headache pain better
than a chemically identical but plainlooking placebo. In other words, two
totally inactive products produced
different results purely on the power
of suggestion. In fact the scientists
concluded that as much as one-third of
the pain-relieving effect of brand name
aspirin is due to psychological expectation of the patient.
If you are convinced that only one
brand of aspirin will do, then that is
the brand you should use. You might
very well notice the difference between
it and an inexpensive generic. If, on
the other hand, you get relief from any
house-brand USP aspirin product, you
are fortunate. You can get your
analgesic action at substantial savings
by shopping comparatively.
COMBINED PAIN RELIEVERS
There are lots of pain relievers on the
market that combine analgesic ingredients. Excedrin, Goody's Headache Powers, Trigesic, Tri-Pain
and Vanquish are just a few of the
products that contain more than one
kind of pain medicine.
6
A panel of experts looked at the
safety of such over-the-counter pain
relievers. In 1984 these scientists
found “the weight of evidence supports
the view that combinations of antipyretic [fever reducing] analgesics
[pain killers] taken in large doses over
long periods can cause kidney disease
and chronic renal failure.”
The experts recommended that the
Food and Drug Administration seriously consider limiting over-thecounter products to those with only
one pain-fighting ingredient. For
unknown reasons the FDA chose to
ignore this suggestion. We'll leave it to
you to decide whether the risk is
worth the benefit.
THE CAFFEINE CONTROVERSY
One of the more controversial questions among pain specialists is
whether caffeine can boost the painkilling power of aspirin. A recent
study published in the Archives of
Internal Medicine suggests that the
answer may actually be yes.
Patients with sore throats were given
either plain aspirin or aspirin with
caffeine (64 mg). According to the
investigators the patients who received the extra caffeine noted greater
pain relief. The study was conducted
in a scientific manner, but paid for by
the makers of Anacin. Not surprisingly, they were pleased with the
results since Anacin contains aspirin
and caffeine.
Whether these results hold any
meaning for people with headaches or
other kinds of pain remains to be
determined. If you want this “magic”
formula you could take your aspirin
with a glass of iced tea or a cup of
coffee and probably achieve much the
same benefit.
FUTURE MIRACLES?
New discoveries of aspirin's incredible powers never seem to stop. In one
recent study people who routinely
used aspirin were reported to have
roughly 50 percent less stomach,
throat, colon and rectal cancer. No one
knows what the next aspirin breakthrough might be, but stay tuned. It's
bound to be breathtaking!
Buffered
Aspirin
Drug companies have
tried to counteract the
direct irritating effects
of aspirin by adding
antacids such as aluminum and magnesium
hydroxide. Some people
do benefit, but regular,
high-dose aspirin
consumption can still
lead to stomach upset
through an indirect
action of aspirin on the
stomach lining. Even if
aspirin could be injected
intravenously it might
still cause stomach
problems for some
people. Don’t assume
that buffered aspirin
guarantees safety.
The Aspirin Handbook :
A User’s Guide to the Breakthrough Drug of the 90s
(Bantam Books, 1993)
by
Joe Graedon, Teresa Graedon, Ph.D.
& Tom Ferguson, M.D.
Everything you ever wanted to
know about aspirin and then
some. We also cover acetaminophen (Tylenol) and ibuprofen
(Advil, Motrin IB, Nuprin,
etc). You will learn lots more
about proper dosing, usage and
precautions. This indispenable
guide is 244 pages and costs
just $4.99. Add $1.00 for postage and handling.
The People's Pharmacy
P.O. Box 52027
Durham, NC 27717-2027
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