Aspirin and Related Drugs

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Aspirin and Related Drugs (salicylates)

Aspirin is commonly used to treat many forms of arthritis. Although aspirin is often very important, medication is only part of a total treatment program for arthritis. You need to learn from your doctor what else to do for your disease. A typical program includes medication therapy as well as exercise, rest, and joint protection. The salicylates are a family of related drugs that reduce the effects of inflammation, a reaction of the body that causes pain, swelling, redness, and heat. The word salicylate refers to the active ingredient in the drugs. Aspirin (acetylsalicylic acid or ASA) is one of these drugs. Many of the others are chemically related to aspirin. Although salicylates differ from each other slightly in chemical structure, they have similar effects in the body. These drugs break down into salicylate, a chemical that is found in the bark of willow trees and in certain plants. Small amounts of salicylate can relieve headaches, mild pain, and fever. Larger amounts taken regularly over a period of time relieve some of the pain, heat, redness, and swelling associated with the inflammation of many forms of arthritis.

Still larger amounts can cause toxicity (poisoning), which may be mild or severe. Patients whose joint pain persists despite aspirin or NSAIDs for joint pain may have a serious orthopedic condition. Older patients with knee pain, hip pain, shoulder pain, or elbow pain may have arthritis, and there are surgical options for managing this -- including minimally-invasive knee replacement, total hip replacement, shoulder replacement, or elbow replacement, depending on the joint involved. Younger patients whose knee pain persists despite NSAIDs may have a meniscus tear, which may be repairable.

Nonsteroidal anti-inflammatory drugs

Aspirin and the other salicylates belong to a group of drugs called nonsteroidal anti-inflammatory drugs (or NSAIDs for short). All NSAIDs have the ability to reduce the effects of inflammation present in most types of arthritis. They are not related to the steroid drugs, which are a different group of well-known anti-inflammatory drugs similar to hormones such as cortisone. The NSAIDs appear to work by blocking the action of various body chemicals, which cause some of the pain and inflammation of arthritis. An advantage of aspirin over the other NSAIDs is that aspirin costs less. Because a person with arthritis must take medication for a long time, aspirin's fairly low cost is often a major factor in the choice of drug treatment.

Patients whose joint pain persists despite aspirin or NSAIDs for joint pain may have a serious orthopedic condition. Older patients with knee pain, hip pain, shoulder pain, or elbow pain may have arthritis, and there are surgical options for managing this -- including minimally-invasive knee replacement, total hip replacement, shoulder replacement, or elbow replacement, depending on the joint involved. Younger patients whose knee pain persists despite NSAIDs may have a meniscus tear, which may be repairable.

Dosage

Arthritis affects people in different ways. For this reason, only your physician can determine how much aspirin you need to effectively treat the symptoms of your disease, and how much you can tolerate. You could make a serious mistake if you tried to figure out your own dosage schedule. Each person's body handles salicylates differently. A certain daily dose may be too small for one person, just right for another, or cause serious toxicity for another. To determine the best dose of aspirin for you, the doctor may check your blood level from time to time. He or she may also ask you to be aware of certain side effects. When the proper dose has been determined, it must be taken regularly. "Regularly" means at certain times of the day, every day--not just when you're in pain. A certain level of aspirin must be maintained in your blood to control swelling, pain, and stiffness. Therefore, the benefits of aspirin may be lost if it is not taken as prescribed by your physician. Different brands of aspirin contain different amounts of the drug in each tablet.

Be sure to check the dosage your doctor has prescribed with the amount per tablet you are taking. A standard tablet contains 5 grains of aspirin, which is equal to 325 milligrams of the drug. Aspirin advertised as "arthritis strength" or "extra strength" contains more aspirin per tablet (usually 500 mg). This is the same amount of aspirin as if you simply took more tablets of another brand with less aspirin in each pill. Many common pain and cold remedies also contain some aspirin. You should not take one of them in addition to your regular aspirin without first checking with your doctor. You could be overdosing yourself without realizing it. Always read the labels of drugs you buy without a prescription before taking them. Check to see if they contain aspirin or other salicylates.

Warnings

Aspirin can be taken safely with many other medications. There are some drugs, however, such as certain ones taken for gout and diabetes, that should not be taken with aspirin. It is very important to tell your doctor all the drugs you are taking for any condition. This includes any medications bought without a prescription and those prescribed by another doctor. Brand selection Always read the ingredients listed on the label of other products, especially those for pain, headaches, and other types of discomfort. "Acetylsalicylic acid" or "salicylate" are the key ingredients to look for.

Not all aspirin or salicylate tablets are the same. They come in several forms that have been developed to be more convenient to take and, sometimes, to help avoid stomach distress. These include liquid forms, buffered tablets, tablets with a special coating (called enteric coating) that keeps them from dissolving in the stomach, and capsules or tablets that release aspirin very slowly into the bloodstream. There are also the other salicylates--the chemically modified types of aspirin--which are longer acting than aspirin and can be taken less often. Non brand-name or generic aspirin usually costs less and works just as well as popular brands. The least expensive way to buy plain aspirin is in bottles of 1,000 tablets. If you tolerate a certain brand, stay with it. Differences in the way various tablets dissolve may cause some brands to irritate the stomach more than other brands.

Packaging

Safety regulations require that aspirin products, like all drugs sold without prescriptions, must be packaged in containers that are both tamper-resistant and child resistant. Unfortunately, these packages may be very difficult to open for people whose hands are affected by arthritis. There are, however, ways to overcome this problem. Most aspirin producers offer one size that is not child-resistant (usually small sizes that aren't as economical as larger ones). If you have trouble opening the packaging or the container itself, ask the pharmacist or clerk to transfer the medicine to an easy-to-open container for you. Friends and family members can do the same. Always keep aspirin and other medications safely out of reach of children to avoid accidental poisonings, which may be fatal.

NSAIDs

Aspirin, salicylates, and many over the counter pain relievers belong to a group of drugs called the nonsteroidal anti-inflammatory drugs (or NSAIDs for short). Three of the main types of NSAIDs that arthritis patient often use are acetaminophen, ibuprofen, and analgesic (pain-relieving) rubs.

Acetaminophen

Acetaminophen is used for relief of headaches, fever, and mild pain. However, it does not reduce the inflammation that is present in many forms of arthritis. Some brand names include Tylenol and Datril. You can substitute it for aspirin or other salicylates to control pain, but not for the reduction of inflammation. Your doctor will let you know whether acetaminophen would be useful for you. Aspirin is often combined with acetaminophen in a single tablet for relief of arthritis and other painful conditions. Sometimes other drugs such as caffeine, an antihistamine, nasal drying agents, and sedatives are also added. Although some of these preparations may have special uses for certain acute conditions such as a cold or a headache, they should not be taken for a chronic (long-term) form of arthritis. If a combination is required, each drug should be prescribed separately. The dose of each should be adjusted individually to achieve the greatest benefit with the fewest side effects.

Ibuprofen

Ibuprofen is an NSAID that is now available without a prescription for control of aches, pains, fever, and menstrual cramps. (Some brand-name examples are Advil and Nuprin.) The benefits of this drug are similar to those of aspirin, but overdoses are less likely to cause serious illness than are overdoses of aspirin.

Analgesic (pain-relieving) rubs

Analgesic (pain-relieving) rubs are liquids or ointments that often contain some form of salicylate. They are meant to be rubbed onto the skin over a painful area such as a joint for short-term pain relief. They produce their effect by creating a sensation of numbness and warmth in the skin, which may provide some feeling of relief from the underlying pain. They may also work as counter-irritants that increase local blood flow and modify the perception of pain. The salicylates and other substances such as menthol and camphor in these rubs are not well absorbed. This means that they do not penetrate the skin and reach underlying painful joints. Only a small amount actually reaches the circulation to be spread throughout the body. These rubs do not reduce inflammation. Analgesic rubs are very toxic if taken internally. They should be kept away from children.

Overdose

Aspirin is very useful, but it has many side effects and therefore must be used carefully. Like most powerful drugs, an overdose of aspirin or salicylates can be fatal. If a child or adult takes an overdose of aspirin, induce vomiting to empty the unabsorbed medication from the stomach (if the person is still awake and conscious). Obtain emergency medical care right away. Common side effects The most common side effects of aspirin are heartburn and other symptoms of stomach irritation such as indigestion, pain, nausea, and vomiting.

The stomach irritation may lead to bleeding from the stomach, which may cause black stools. These symptoms may be reduced by taking aspirin with meals, with an antacid, with a glass of milk, or by taking enteric-coated or timed-release aspirin. Also, it is best not to take aspirin with alcohol or coffee (or other beverages containing caffeine, such as tea or cocoa and many soft drinks). Alcohol and caffeine make the stomach more sensitive to irritation. The non aspirin salicylate preparations sometimes are less irritating to the stomach and may be substituted for aspirin by your doctor.

Other effects

A few people develop asthma, hay fever, nasal congestion, or hives from aspirin or NSAIDs. These people should never take aspirin, nor should people who have active stomach or duodenal ulcers. Anyone who has ever had a peptic ulcer should be very careful about taking aspirin because it can lead to a recurrence. Aspirin is known to interfere with the action of the platelets (blood cells involved in clotting). As a result, some people who take a lot of aspirin experience easy bruising of the skin. Therefore, people who have major bleeding problems should not take aspirin. Also, keep in mind that aspirin should not be taken for 10-14 days before surgery (including surgery in the mouth) to avoid excessive bleeding during or after the operation.

High doses of salicylate may cause ringing in the ears and slight deafness. If these effects occur, reduce your dose and call your doctor for further instructions. Your physician may decide to check your blood aspirin level and may even ask you to tolerate these symptoms without cutting your dose. Sometimes, however, these symptoms indicate mild overdose, which could become more serious. This problem should be discussed carefully with your doctor. Aspirin and NSAIDs sometimes affect the normal function of the kidneys, or they can cause fluid to accumulate in the body. If you have liver, kidney, or breast disease, get your doctor's advice before taking these drugs. If you begin to swell up, gain a lot of weight, or feel ill while taking one of these drugs, stop taking it immediately and contact your doctor.

Effects on children

Recent reports have said there could be a link between the use of aspirin and the development of Reye's syndrome. Reye's syndrome is a rare but possibly fatal disease seen most often in children and teenagers. It usually affects those recovering from chicken pox or a viral illness such as the flu. These reports have raised concern in pediatricians (doctors who specialize in treating children) and parents of children with arthritis who need to take large doses of aspirin to control their disease. Presently, there is no conclusive proof showing how often Reye's syndrome occurs in children with arthritis who are or are not taking aspirin.

Results from a survey of doctors who specialize in childhood arthritis and related diseases have not shown that children with arthritis who regularly take large doses of aspirin have a high risk of developing Reye's syndrome. There have been some reports of a few children with arthritis developing Reye's syndrome. At present, there appears to be no reason to limit the use of aspirin in children with arthritis. However, if a child with arthritis who is taking aspirin develops symptoms of chicken pox, flu, or any viral illness that has fever as a symptom, the aspirin should be stopped. The child's doctor should be contacted right away.

Getting proper medical help

Many aspirin ads and commercials make arthritis sound as if it were nothing more than minor aches and pains. The truth is that arthritis can be serious, the pain can be extreme, and it can cause deformity unless a careful treatment program is begun early in the course of the disease. Don't let advertising lead you to diagnose and treat yourself for arthritis. There is much more to controlling arthritis than getting "wonderful relief." Arthritis isn't something to fool around with. If you medicate yourself and stay away from the doctor, your affected joints may suffer damage that can't be reversed. Take arthritis seriously and get proper medical help.

Unproven remedies

Unproven remedies are treatments that have not yet shown that they both work and are safe. They can include products, drugs, diets, and procedures. Sometimes "special formula" medicines are promoted for the relief of arthritis. Often these contain more than one ingredient, and the chief one (the only one that may help the arthritis) is some form of aspirin. These products may be offered at very high prices. In addition, keep in mind that, because of the changing course of arthritis, it may appear that an unproven remedy caused improvement. The best guide to remember is to stay with your prescribed treatment plan. It involves treatments that have worked and have been proven safe in large numbers of people. Although some unproven remedies are not dangerous, others can be very harmful. If you have questions about an unproven remedy, contact your doctor.

Seeking Professional Advice

Patients whose joint pain persists despite aspirin or NSAIDs for joint pain may have a serious orthopedic condition. Older patients with knee pain, hip pain, shoulder pain, or elbow pain may have arthritis, and there are surgical options for managing this -- including minimally-invasive knee replacement, total hip replacement, shoulder replacement, or elbow replacement, depending on the joint involved. Younger patients whose knee pain persists despite NSAIDs may have a meniscus tear, which may be repairable.

Promising findings

Current research efforts are continuing to find possible new uses for aspirin. In the field of immunology (the study of the body's immune system), promising results have been reported in which aspirin has helped strengthen the body's immune system. This could provide new information about aspirin's effect on the course of rheumatoid arthritis, a disease in which the immune system is defective. Also, recent studies have suggested that daily, low doses of aspirin may reduce blood clotting and therefore lower a person's risk of stroke or heart attack.

Things to remember

Do see a qualified physician for diagnosis and treatment of arthritis. Avoid or reduce serious problems by not trying to treat yourself. Proper treatment prescribed by a physician can control the disease and lessen joint damage. Do take aspirin, if the doctor prescribes it, in the exact amount and the exact schedule he or she has told you to take it. Don't change your aspirin dosage schedule without first asking your physician. Don't be lured by advertising into treating yourself on a homemade schedule. Even though arthritis may begin with "minor aches and pains," it is nothing to fool around with. If pain continues and stiffness and joint swelling occur, get qualified medical advice and get it early. Be careful of unproven remedies.

Before you buy or try, consult your physician. If a child with arthritis who is taking aspirin develops symptoms of chicken pox, flu, or any viral illness that has fever as a symptom, stop the aspirin. Contact the doctor right away. Women who become pregnant should discuss with their physicians whether or not to continue taking aspirin or similar products. If you have further questions regarding aspirin or any other medication, be sure to consult your doctor.

Credits

The Arthritis Foundation and the University of Washington Department of Orthopedics do not endorse any brand name or generic name medication listed here. Some of this material may also be available in an Arthritis Foundation brochure. Adapted from the pamphlet originally prepared for the Arthritis Foundation by Harold E. Paulus, M.D. and Paul H. Plotz, M.D. This material is protected by copyright.