Aspirin side effects Many adverse reactions due to aspirin ingestion are dose- related. The following is a list of adverse reactions that have been reported in the literature (Arif & Aggarwal, 2023). ● General : Fever, hypothermia, thirst. ● Cardiovascular : Dysrhythmias, hypotension, tachycardia. ● Central nervous system : Agitation, cerebral edema, coma, confusion, dizziness, headache, subdural or intracranial hemorrhage, lethargy, seizures. ● Fluid and electrolyte : Dehydration, hyperkalemia, metabolic acidosis, respiratory alkalosis. ● Gastrointestinal : Dyspepsia, GI bleeding, ulceration and perforation, nausea, vomiting, transient elevations of hepatic enzymes, hepatitis, Reye’s syndrome, pancreatitis. ● Hematologic : Prolongation of the prothrombin time, disseminated intravascular coagulation, coagulopathy, thrombocytopenia. ● Hypersensitivity : Acute anaphylaxis, angioedema, asthma, bronchospasm, laryngeal edema, urticaria ● Musculoskeletal : Rhabdomyolysis. ● Metabolism : Hypoglycemia (in children), hyperglycemia. ● Reproductive : Prolonged pregnancy and labor, stillbirths, lower birth weight infants, antepartum and postpartum bleeding. ● Respiratory : Hyperpnea, pulmonary edema, tachypnea. ● Special senses : Hearing loss, tinnitus; people with high frequency hearing loss may have difficulty perceiving tinnitus. ● Urogenital : Interstitial nephritis, papillary necrosis, proteinuria, renal insufficiency and failure. ● Nonacetylated salicylates : magnesium salicylate (Doan’s pills) sodium salicylate, and salicylate (Disalcid). The exact mechanism of action of acetaminophen is not known. Acetaminophen relieves pain by elevating the pain threshold, that is, by requiring a greater amount of pain to develop before it is felt by a person. It reduces fever through its action on the heat-regulating center of the brain. Specifically, it tells the center to lower the body’s temperature when the temperature is elevated (Gerriets et al., 2023). Acetaminophen is used for the relief of fever as well as aches and pains associated with many conditions. Acetaminophen relieves pain in mild arthritis but has no effect on the underlying inflammation, redness and swelling of the joint. If the pain is not due to inflammation, acetaminophen is as effective as aspirin. It is as effective as the nonsteroidal anti-inflammatory drug ibuprofen in relieving the pain of osteoarthritis of the knee (Gerriets et al., 2023). Acetaminophen is metabolized (eliminated by conversion to other chemicals) by the liver. Therefore, drugs that increase the action of liver enzymes that metabolize acetaminophen (e.g., carbamazepine, isoniazid, rifampin) may decrease the action of acetaminophen. The potential for acetaminophen to harm the liver is increased when it is combined with alcohol or drugs that also harm the liver. When used appropriately, side effects are rare. The most serious side effect is liver damage due to large doses, chronic use, or concomitant use with alcohol or other drugs that also damage the liver (Gerriets et al., 2023). Acetaminophen is excreted in breast milk in small quantities. However, acetaminophen use by the nursing mother appears to be safe. Acetaminophen has been used in all stages of pregnancy (Gerriets et al., 2023).
● Uricosuric agents (probenecid and sulfinpyrazone) : Salicylates antagonize the uricosuric action of uricosuric agents. ● Carcinogenesis, mutagenesis, impairment of fertility : Administration of aspirin for 68 weeks at 0.5 percent in the feed of rats was not carcinogenic. In the Ames Salmonella assay, aspirin was not mutagenic; however, aspirin did induce chromosome aberrations in cultured human fibroblasts. Aspirin inhibits ovulation in rats. (See Pregnancy.) ● Pregnancy : Pregnant women should only take aspirin if clearly needed. Because of the known effects of NSAIDs on the fetal cardiovascular system (closure of the ductus arteriosus), use during the third trimester of pregnancy should be avoided. Salicylate products have also been associated with alterations in maternal and neonatal hemostasis mechanisms, decreased birth weight, and with perinatal mortality. ● Labor and delivery : Aspirin should be avoided 1 week prior to and during labor and delivery because it can result in excessive blood loss at delivery. Prolonged gestation and prolonged labor due to prostaglandin inhibition have been reported. ● Nursing mothers : Nursing mothers should avoid using aspirin because salicylate is excreted in breast milk. Use of high doses may lead to rashes, platelet abnormalities, and bleeding in nursing infants. ● Pediatric use : Pediatric dosing recommendations for juvenile rheumatoid arthritis are based on well-controlled clinical studies. Acetaminophen (Tylenol ® ) Acetaminophen is a drug with antipyretic and analgesic effects similar to those of aspirin and NSAIDs, but with limited anti-inflammatory or antirheumatic effects. It is used to treat mild to moderate pain. Unlike aspirin and related drugs, acetaminophen is not irritating to the stomach. While people rarely have any side effects from the usual dose of acetaminophen, liver and kidney damage may result from using large doses of this medicine every day for a long time or drinking alcohol with the usual dose. Even moderate amounts of alcohol can produce liver damage in people taking acetaminophen (Gerriets et al., 2023). Acetaminophen is administered orally with absorption associated with the rate of gastric emptying. Peak blood concentrations usually occur within one-half to one hour. In large doses, a highly active metabolite is associated with acetaminophen’s toxicity to the liver and kidneys. The half-life of this drug is two to three hours and is generally unaffected by renal function. With large doses or in the case of liver disease, the half-life duration may double (Gerriets et al., 2023). Unlike NSAIDs, acetaminophen does not have anti- inflammatory properties, so it does not affect uric acid levels and platelet function. Patients allergic to aspirin, those unable to take salicylates, individuals with hemophilia, a history of peptic ulcer, or those with aspirin-associated bronchospasms should not take acetaminophen. It is also often used in children with viral infections. Larger doses may cause dizziness, excitement, and disorientation. Early symptoms of hepatic damage include nausea, diarrhea, vomiting, and abdominal pain. There have also been rare cases of renal damage (Gerriets et al., 2023).
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