● Sodium restricted diets : People with sodium-retaining states, such as congestive heart failure or renal failure, should avoid sodium-containing buffered aspirin preparations because of their high sodium content. Drug interactions with aspirin ● Angiotensin converting enzyme (ACE) inhibitors : The hyponatremic and hypotensive effects of ACE inhibitors may be diminished by the concomitant administration of aspirin due to its indirect effect on the renin-angiotensin conversion pathway. ● Acetazolamide : Concurrent use of aspirin and acetazolamide can lead to high serum concentrations of acetazolamide (and toxicity) due to competition at the renal tubule for secretion. ● Anticoagulant therapy (heparin and warfarin) : People on anticoagulation therapy are at increased risk for bleeding because of drug interactions and the effect on platelets. Aspirin can displace warfarin from protein binding sites, leading to prolongation of both the prothrombin time and the bleeding time. Aspirin can increase the anticoagulant activity of heparin, increasing bleeding risk. ● Anticonvulsants : Salicylate can displace protein-bound phenytoin and valproic acid, leading to a decrease in the total concentration of phenytoin and an increase in serum valproic acid levels. ● Beta blockers : The hypotensive effects of beta blockers may be diminished by the concomitant administration of aspirin due to inhibition of renal prostaglandins, leading to decreased renal blood flow, and salt and fluid retention. ● Diuretics : The effectiveness of diuretics in people with underlying renal or cardiovascular disease may be diminished by the concomitant administration of aspirin due to inhibition of renal prostaglandins, leading to decreased renal blood flow and salt and fluid retention. ● Methotrexate : Salicylate can inhibit renal clearance of methotrexate, leading to bone marrow toxicity, especially in the elderly or renal impaired. ● Nonsteroidal anti-inflammatory drugs (NSAIDs) : The concurrent use of aspirin with other NSAIDs should be avoided because this may increase bleeding or lead to decreased renal function. ● Oral hypoglycemics : Moderate doses of aspirin may increase the effectiveness of oral hypoglycemic drugs, leading to hypoglycemia. ● 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.) 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
Aspirin has been associated with elevated hepatic enzymes, blood urea nitrogen and serum creatinine, hyperkalemia, proteinuria, and prolonged bleeding time (Arif & Aggarwal, 2023). ● 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. 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). 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).
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Book Code: MTX1325
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