Aspirin and Related Drugs (NSAIDs).
Last updated Friday, May 11, 2007
About aspirin and NSAIDsAspirin 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 orthopaedic 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 orthopaedic 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 orthopaedic 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 Orthopaedics 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. Contact the Washington/Alaska Chapter Helpline: (800)
542-0295. If dialing from outside of WA and AK, contact the National
Helpline: (800) 283-7800.
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.
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