Aspirin Drug Profile

What is Aspirin?

Aspirin (acetylsalicylic acid) is a widely used medication that belongs to the antiplatelet class of drugs and is also classified as a nonsteroidal anti-inflammatory drug (NSAID). Originally developed as a pain reliever and fever reducer, aspirin is now commonly prescribed in low doses to prevent blood clots and reduce the risk of heart attacks and strokes. It is one of the most extensively studied medications and has been in clinical use for over a century.

Uses

Aspirin has several well-established medical uses:

• Cardiovascular disease prevention: Low-dose aspirin (75-100mg daily) is prescribed to reduce the risk of heart attacks and ischemic strokes in patients with existing cardiovascular disease or those at high risk.
• Pain relief: Higher doses (325-650mg) are used to treat mild to moderate pain, including headaches, muscle aches, and joint pain.
• Fever reduction: Aspirin effectively reduces fever in adults, though it should not be used in children due to the risk of Reye’s syndrome.
• Anti-inflammatory treatment: Used to reduce inflammation in conditions such as rheumatoid arthritis, though other NSAIDs are often preferred for this purpose.
• Acute coronary syndrome: Administered immediately during heart attacks to help prevent further clot formation and reduce heart muscle damage.

How it works

Aspirin works by permanently blocking an enzyme called cyclooxygenase-1 (COX-1), which is essential for producing substances called prostaglandins and thromboxanes. By inhibiting COX-1, aspirin reduces the production of thromboxane A2, a powerful substance that causes blood platelets to stick together and form clots. This antiplatelet effect makes aspirin particularly valuable for preventing cardiovascular events, while its interference with prostaglandin production also accounts for its pain-relieving, fever-reducing, and anti-inflammatory properties.

Side effects

Common side effects:

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• Stomach upset and heartburn
• Nausea and vomiting
• Easy bruising
• Prolonged bleeding from minor cuts
• Stomach pain or cramping
• Ringing in the ears (tinnitus)
• Dizziness
• Allergic skin reactions

Serious side effects requiring immediate medical attention:

• Gastrointestinal bleeding (black, tarry stools or vomiting blood)
• Severe allergic reactions including difficulty breathing or swelling
• Signs of bleeding in the brain (severe headache, vision changes, weakness)
• Liver problems (yellowing of skin or eyes, dark urine)
• Kidney dysfunction (changes in urination, swelling)

Warnings and precautions

• Children and teenagers: Should not receive aspirin during viral infections due to the risk of Reye’s syndrome, a rare but potentially fatal condition.
• Pregnancy: Generally avoided during pregnancy, especially in the third trimester, as it may cause complications during delivery and affect the developing baby’s heart and blood vessels.
• Bleeding disorders: Patients with bleeding disorders, active ulcers, or those scheduled for surgery should avoid aspirin due to increased bleeding risk.
• Kidney and liver disease: Dose adjustments or avoidance may be necessary in patients with significant kidney or liver impairment.
• Asthma: Some people with asthma may experience severe allergic reactions to aspirin, known as aspirin-exacerbated respiratory disease.

Interactions

• Warfarin and other blood thinners: Significantly increases bleeding risk when combined with aspirin
• Methotrexate: Aspirin can increase methotrexate toxicity by reducing its elimination from the body
• ACE inhibitors and ARBs: May reduce the effectiveness of these blood pressure medications
• Ibuprofen and other NSAIDs: Can interfere with aspirin’s cardioprotective effects and increase gastrointestinal bleeding risk
• Alcohol: Increases the risk of stomach bleeding and liver damage
• Corticosteroids: May increase the risk of gastrointestinal bleeding when used with aspirin
• Ginkgo biloba: This supplement may further increase bleeding risk when combined with aspirin
• Insulin and diabetes medications: Aspirin may enhance blood sugar-lowering effects

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Dosage

Aspirin dosing varies significantly based on the intended use. For cardiovascular protection, low-dose aspirin typically ranges from 75-100mg once daily. For pain relief and fever reduction, adults usually take 325-650mg every 4 hours as needed, not exceeding 4,000mg in 24 hours. For anti-inflammatory effects, higher doses of 2,400-3,600mg daily divided into multiple doses may be prescribed. The specific dosage should always be determined by a healthcare provider based on individual patient factors, medical history, and treatment goals. Patients should not exceed recommended doses or duration without medical supervision.

Sources: FDA DailyMed drug labels (public domain), BNF, WHO Essential Medicines List. This article is for informational purposes only and does not constitute medical advice. Always consult your healthcare provider before starting or stopping any medication.

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