cover bar Title: Aspirin: Upside, Downside
Author: Jennifer James
Publisher: Do It Now Foundation
Publication Date: October 2002
Catalog Number: 138

..'Four Out of Five Doctors Recommend...'

If you've watched the evening news on TV more than three times in your life, you might think you know all there is to know about aspirin.

Because in that short time, you would have seen aspirin buffered and time-released, extra-strengthed and effervesced, in a dozen different forms in a dozen different commercials.

You'd have seen it rush to where it hurts five times faster while it was twice as gentle to your stomach, unclanging bell-ringer headaches as it neutralized neuritis, neuralgia, and a long list of muscular aches and pains.

You'd have seen migraines pampered and vanquished, and arthritis pain formulized out of existence. And, increasingly, you would have heard it extolled as a way of preventing heart attacks.

But what would you really know about the most widely-used pain reliever of all time?
Not much, probably. Because in spite of the enormity of aspirin use, most of us know less about it than any other drug.

Oh, we know it works -- usually, when taken as directed -- but that's about it. And there's a lot more to it than that.

Because aspirin is a drug. And although it's safe and cheap and effective, it can be dangerous -- even deadly -- when used incorrectly or in larger-than-recommended doses.
That's why we've put this pamphlet together.

We think it's your right -- your obligation, even -- to know about this popular and potent drug. And knowing more about aspirin could save you, or someone you care about, a headache or two -- or even a doctor or hospital bill someday.

Want to know more? Then read on...

..Aspirin, the Drug

Since its commercial introduction in 1899 by the Bayer Company, worldwide popularity of acetylsalicylic acid -- better known as aspirin -- has grown steadily. And so has the variety of aspirin available.

Today the drug is sold in everything from tablets and capsules to chewing gum and elixirs. It's combined with caffeine and countless other drugs, both prescription and over-the-counter.
It's swallowed to prevent heart attacks and taken to relieve headaches, fever, rheumatism, arthritis, inflammation, hangovers, and other disorders, real and imagined.

It's available wherever you might happen to be: grocery and drug stores, gas stations, airports, restaurants, glove compartments, purses, and desk drawers.

But no matter what form you buy or where you find it, all aspirin works in the same way: by blocking production of hormone-like chemicals (called prostaglandins) involved in everything from blood circulation and clotting to body temperature, digestion, and breathing.

At high levels, prostaglandins cause pain -- and aspirin just eats up pain.

..Uses, Abuses

When used correctly, aspirin is a wonder drug. Its ability to relieve pain is unequaled even by many highly-touted prescription drugs.

But for best results, it's important to use aspirin only as directed. Other points to keep in mind:
Don't take aspirin on an empty stomach, and be sure to wash it down with a glass of water. Relief begins within minutes; peak effect is reached in about two hours.

Some experts say a good way to take aspirin is to crush it and mix it with orange juice or honey and lemon to reduce stomach irritation and permit faster absorption.

There are also a number of possible side effects and other problems you should be aware of if you take aspirin. Just consider these, for starters:

For some users, aspirin can cause ringing in the ears, dizziness, vomiting, and hearing loss. Such symptoms usually disappear when aspirin use stops.

The most common effect of overuse is stomach upset -- from pain and nausea to bleeding ulcers and chronic indigestion.

Regular aspirin use also damages the kidneys and can trigger sudden renal failure.

..Overuse, Overdose

Still, the greatest danger of overuse is overdose. As little as 10 grams -- about 30 regular-strength tablets -- can be fatal in adults. In 1996, aspirin ranked eighth among all drugs as a cause of overdose and poisoning.

A reason aspirin ranks so high is simple availability.

A bottle is always around somewhere, waiting to be downed by a curious child (aspirin is still a leading cause of poisoning in kids) or by adults who think that if a little aspirin makes them feel better, a lot will make them feel wonderful.

These are the people statistics are made of.

That's why aspirin overdoses should always be regarded as life-threatening emergencies requiring fast medical attention.

As with any other drug, users should also be careful about interactions with other drugs. Aspirin interferes with many types of medication, including drugs taken for gout, diabetes, and kidney disease.

Its effects are also altered by vitamin C, which slows elimination of the drug from the body, and by alcohol. And despite its use as a hangover cure, aspirin is even more irritating to the stomach when used with alcohol.

..Other Problems

Even when taken as directed, aspirin still stirs up problems for some people.

Those with conditions such as hemophilia, asthma, or allergies should consult their doctors before using any amount of the drug.

Because aspirin can disrupt normal blood clotting and cause bleeding, it should be avoided at least one week prior to surgery and during pregnancy.

In fact, evidence of the drug's dangers in pregnancy -- including prolonged labor, heavier bleeding, and abnormal clotting in mother and child -- has prompted federal officials to recommend warning labels for all aspirin products.

Children and teenagers are also better off with substitutes. Aspirin can trigger a serious, often fatal sickness called Reye's syndrome in young people recovering from chicken pox or the flu.

The syndrome can cause brain damage and death. Because of the risks, aspirin makers are required by law to add warning labels about Reye's syndrome to product packages.

..Aspirin Alternatives

If you're one of the people who can't take aspirin, there are alternatives.

The most popular is acetaminophen, sold under the brand-names Tylenol and Datril (among others). Acetaminophen reduces fever and pain, but doesn't ease inflammation. On the other hand, acetaminophen causes less stomach upset.

Ibuprofen, sold under the brand-names Advil and Nuprin, was introduced as a nonprescription pain reliever in 1984. It works like aspirin to block both fever and swelling and may work better against certain types of pain, like menstrual cramps.

But even aspirin alternatives aren't entirely safe.

Both can cause overdose -- and, in recent years, each has surpassed aspirin as a cause of hospitalization. And both acetaminophen and ibuprofen appear to damage kidneys with regular use.

Some reports have even linked ibuprofen to a reversible, temporary form of kidney failure in as many as a quarter of patients studied.

Should none of these over-the-counter drugs satisfactorily reduce discomfort, pain may be a sign of a more serious problem warranting a doctor's attention. For more severe pain, a physician can prescribe other preparations, including narcotics and synthetic pain relievers.

..Consumer, Be Wise

Pointing out its possible risks isn't meant to turn people away from moderate aspirin use.

Aspirin really is a wonder drug -- as effective at stopping pain as many prescription analgesics,
and its beneficial effects on health only make it that much more of a boon than it has been all along.

Just about the only thing aspirin lacks is the "magic" that occurs when a doctor writes a prescription for an expensive prescription drug. This "magic" relieves pain about half the time -- even when the contents of the capsule are only sugar.

But unlike the "magic" of placebos, the magic of aspirin resides in the aspirin molecule itself. And all aspirin is alike. It has to be to be aspirin.

No matter what some brand-name aspirin makers say in their TV ads, there's no real difference between brand-name and no-name aspirin. When you buy expensive brands, the extra money pays for advertising -- not "faster" or "better" pain relief.

Aspirin is aspirin, and it works and it's safe -- if you're careful -- whether it costs 99 cents or $9.99.

..Sidebar | Rx for the Heart

After a century on the job, aspirin's still working wonders -- and in wondrous new ways.
Beyond its role as a pain reliever, aspirin is showing value in preventing ischemic (clotting) strokes and in slowing the formation of cataracts.

Perhaps even more important is the drug's role in preventing heart attack by slowing development of blood clots in arteries leading to the heart.

Researchers at Harvard Medical School concluded a six-year study by saying that healthy men over age 50 can cut their heart attack risk in half by taking a single aspirin, every other day.

But don't head for the medicine cabinet just yet. Head to the doctor, if you think you might benefit. And even then, you should be aware of two key points:

More is not better. There's no evidence that gulping more aspirin more often will improve your chances of avoiding a heart attack.

Aspirin is not a substitute for other preventive measures, such as losing weight and stopping smoking.

In addition, regular aspirin use may increase risks of bleeding stroke, which is more often fatal than ischemic stroke.

Best advice? Check with your doctor to see if benefits outweigh possible risks in your case. The alternative can be every bit as deadly as a heart attack.

This is one in a series of publications on drugs, behavior, and health by Do It Now Foundation.
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