Summary
Aspirin (acetylsalicylic acid) is probably the most frequently used medication, and its use is generally uneventful. However, aspirin is also noted for numerous side effects and drug interactions that can complicate the course of therapy. The elderly, especially those with complicated medical histories, are more prone to the adverse effects of salicylates and may develop gastrointestinal tract bleeding, renal insufficiency, asthma and CNS toxicity. In the clinical situation, important drug interactions can occur with concurrent use of anticoagulants, sulphonylureas, diuretics, methotrexate and antacids.
In long term aspirin therapy, enteric-coated or nonacetylated forms of aspirin are associated with fewer side effects and may be better tolerated. Monitoring of therapy (especially in the higher risk patient), with frequent assessments of the clinical state and measurements of serum creatinine, electrolytes and salicylate concentrations, may diminish the likelihood of toxicity.
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References
Anderson RJ. Asterixis as a manifestation of salicylate toxicity. Annals of Internal Medicine 95: 188–189, 1981
Anderson RJ, Potts DE, Gabow PA, Rumack BH, Schrier RW. Unrecognised adult salicylate intoxication. Annals of Internal Medicine 85: 745–748, 1976
April PA, Abeles M, Baraf HSB, Cohen SA, Curran NJ, et al. Does the acetyl group of aspirin contribute to the anti-inflammatory efficacy of salicylic acid in the treatment of rheumatoid arthritis? Journal of Rheumatology 16: 321–327, 1989
Armstrong CP, Blower AI. Non-steroidal anti-inflammatory drugs and life threatening complications of peptic ulceration. Gut 28: 527–532, 1987
Asad SI, Kemeny DM, Youlten LJF, Frankland AW, Lessof MH. Effect of aspirin in ‘aspirin sensitive’ patients. British Medical Journal 288: 745–748, 1984
Ayres JW, Wiedler DJ, Mackichan J, Wagner JG. Orcadian rhythm of urinary pH in man with and without chronic antacid administration. European Journal of Clinical Pharmacology 12: 415–420, 1977
Bailey RB, Jones SR. Chronic salicylate intoxication: a common cause of morbidity in the elderly. Journal of the American Geriatric Society 37: 556–561, 1989
Bloom BS. Risk and cost of gastrointestinal side-effects associated with non-steroidal drugs. Archives of Internal Medicine 149: 1019–1022, 1989
Booker JA. Haematemesis and melaena in the elderly. Age and Ageing 12: 49–54, 1983
Caradoc-Davies TH. Non-steroidal anti-inflammatory drugs, arthritis and gastrointestinal bleeding in elderly patients. Age and Ageing 13: 295–298, 1984
Chafee FH, Settipane GA. Aspirin intolerance I: frequency in an allergic population. Journal of Allergy and Clinical Immunology 53: 193–199, 1974
Champion RH, Roberts SOB, Carpenter RG. Urticaria and angioedema: a review of 554 patients. British Journal of Dermatology 81: 558–597, 1969
Coggon D, Langman MJS, Spiegelhalter D. Aspirin, paracetamol and hematemesis and melena. Gut 23: 340–344, 1982
Cumy G, Royer RJ, Miur JM, Serot JM, Faure G, et al. Pharmacokinetics of salicylate in elderly. Gerontology 25: 49–55, 1979
Dale J, Myhre E, Loew B. Bleeding during acetylsalicylic acid and anticoagulant therapy in patients with reduced platelet reactivity after aortic valve replacement. American Heart Journal 99: 746–752, 1980
Davies DF, Shock NW. Age changes in glomerular filtration rate, effective renal plasma flow, and tubular excretory capacity in adult males. Journal of Clinical Investigation 29: 496–507, 1950
Faulkner G, Prichard PJ, Somerville KW, Langman MJS. Aspirin and bleeding peptic ulcers in the elderly. British Medical Journal 297: 1311–1313, 1988
Flower RJ, Moncada S, Vane JR. Analgesic-antipyretics and anti-inflammatory agents: drugs employed in the treatment of gout. In Gilman et al. (Eds). The pharmacological basis of therapeutics, 7th ed., pp. 674–715, MacMillan Publishing Company, New York, 1985
Furst DE, Gupta N, Paulus HE. Salicylate metabolism in twins: evidence suggesting a genetic influence and induction of salicylurate formation. Journal of Clinical Investigation 60: 32–42, 1977
Graham DY, Smith JL. Aspirin and the stomach. Annals of Internal Medicine 104: 390–398, 1986
Greer HD, Ward HP, Corbin KB. Chronic salicylate intoxication in adults. Journal of the American Medical Association 193: 555–558, 1965
Grossman MI, Matsumoto KK, Lichter RJ. Fecal blood loss produced by oral and intravenous administration of various salicylates. Gastroenterology 40: 383–388, 1961
Gupta N, Sarkissian E, Paulus HE. Correlation of plateau serum salicylate level with rate of salicylate metabolism. Clinical Pharmacology and Therapeutics 18: 350–355, 1975
Hayes AH. Therapeutic implications of drug interactions with acetaminophen and aspirin. Archives of Internal Medicine 141: 301–304, 1981
Hurwitz N. Predisposing factors in adverse reactions to drugs. British Medical Journal 1: 536–539, 1969
Huskisson EC. How to choose a non-steroidal anti-inflammatory drug. Clinics in Rheumatic Diseases 10: 313–323, 1984
Jabbari M, Valberg LS. Role of acid secretion in aspirin induced gastric mucosal injury. Canadian Medical Association Journal 102: 178–181, 1970
Johnson PC. Gastrointestinal consequences of treatment with drugs in elderly patients. Journal of the American Geriatrics Society 30: S52–S57, 1982
Keystone EC, Paton TW, Littlejohn G, Verdejo A, Piper S, et al. Steady state plasma levels of salicylate in patients with rheumatoid arthritis: effects of dosing intervals and tablet strength. Canadian Medical Association Journal 127: 283–286, 1982
Kimberly RP, Plotz PH. Aspirin induced depression of renal function. New England Journal of Medicine 296: 418–424, 1977
Kimberly RP, Plotz PH. Salicylates including aspirin and sulfasalazine. In Kelley et al. (Eds) Textbook of rheumatology, 3rd ed., pp. 739–764, W.B. Saunders Company, Philadelphia, 1989
Kitchingman GK, Prichard PJ, Daneshmend TK, Walt RP, Hawkey CJ. Enhanced gastric mucosal bleeding with doses of aspirin used for prophylaxis and its reduction by ranitidine. British Journal of Clinical Pharmacology 28: 581–585, 1989
Klotz U. Interactions of analgesics with other drugs. American Journal of Medicine 75: 133–138, 1983
Leonards JR, Levy G. Aspirin-induced occult gastrointestinal blood loss. Local versus systemic effects. Journal of Pharmaceutical Science 59: 1511–1513, 1970
Levy G, Lampman T, Kamath BL, Garrettson LK. Decreased serum salicylate concentration in children with rheumatic fever treated with antacid. New England Journal of Medicine 293: 323–325, 1975
Levy G, Tsuchiya T, Amsel LP. Limited capacity for salicyl phenolic glucuronide formation and its effect on the kinetics of salicylate elimination in man. Clinical Pharmacology and Therapeutics 13: 258–268, 1972
Loiudice TA, Saleem T, Lang JA. Cimetidine in the treatment of gastric ulcer induced by steroidal and non-steroidal anti-inflammatory agents. American Journal of Gastroenterology 75: 104–110 1981
McDonald JR, Mathison DA, Stevenson DD. Aspirin intolerance in asthma: detection by oral challenge. Journal of Allergy and Clinical Immunology 50: 198–207, 1972
Montgomery PR, Berger LG, Mitenko PA, Sitar DS. Salicylate metabolism. Effects of age and sex in adults. Clinical Pharmacology and Therapeutics 39: 571–576, 1986
Moore-Robinson M, Warin RP. Effect of salicylates in urticaria. British Medical Journal 4: 262–264, 1967
Morassut P, Yang W, Karsh J. Aspirin intolerance. Seminars in Arthritis and Rheumatism 19: 22–30, 1989
Morgan J, Furst DE. Implications of drug therapy in the elderly. Clinics in Rheumatic Disease 12: 227–224, 1986
Needs CJ, Brooks PM. Clinical Pharmacokinetics of the salicylates. Clinical Pharmacokinetics 10: 164–177, 1985
O’Brien JD, Burnham WR. Bleeding from peptic ulcers and use of non-steroidal anti-inflammatory drugs in the Romford area. British Medical Journal 291: 1609–1610, 1985
O’Brien WM, Bagby GF. Anaphylactoid reactions to non-steroidal anti-inflammatory drugs. Advances in Inflammation Research 6: 203–207, 1984
O’Callaghan JW, Thompson RN, Russell AS. Combining NSAIDs with anticoagulants: yes and no. Canadian Medical Association Journal 131: 857–859, 1984
Owen SG, Roberts MS, Friesen WT, Francis HW. Salicylate pharmacokinetics in patients with rheumatoid arthritis. British Journal of Clinical Pharmacology 28: 449–461, 1989
Paulus HE, Siegel M, Mongan E, Okun R, Calabro JJ. Variations in serum concentrations and half life of salicylates in patients with rheumatoid arthritis. Arthritis and Rheumatism 14: 527–532, 1971
Peto R, Gray R, Collins R, Wheatley K, Hennekens C, et al. Randomized trial of prophylactic daily aspirin in British male doctors. British Medical Journal 296: 313–316, 1988
Picrson RN, Holt PR, Watson WN, Keating RP. Aspirin and gastrointestinal bleeding. American Journal of Medicine 31: 259–265, 1961
Prichard PJ, Kitchingman GK, Walt RP, Dameshmend TK, Hawkey CJ. Human gastric mucosal bleeding induced by low dose aspirin, but not warfarin. British Medical Journal 298: 493–496, 1989
Roth SH. Merits and liabilities of NSAID therapy. Rheumatic Disease Clinics of North America 15: 479–498, 1989
Roth SH, Agrawal N, Mahowald M, Montoya H, Robbins D, et al. Misoprostol heals gastrointestinal injury in patients with rheumatoid arthritis. Archives of Internal Medicine 149: 775–779, 1989
Roth SH, Bennett RE, Mitchell CS, Hartman RJ. Cimetidine therapy in non-steroidal anti-inflammatory drug gastropathy: double blind, long-term evaluation. Archives of Internal Medicine 147: 1798–1801, 1987
Rowe JW, Andres R, Tobin JD, Norris AH, Schock NW. The effect of age on creatinine clearance in man: a cross sectional and longitudinal therapy. Journal of Gerontology 31: 155–163, 1976
Rumble RH, Brooks PM, Roberts MS. Metabolism of salicylate during chronic aspirin therapy. British Journal of Clinical Pharmacology 9: 41–45, 1980
Samter M, Beers RF. Intolerance to aspirin. Clinical studies and consideration of its pathogenesis. Annals of Internal Medicine 68: 975–983, 1968
Schachter D, Manis JG. Salicylate and salicyl conjugates: fluorimetric estimation, biosynthesis and renal excretion in man. Journal of Clinical Investigation 37: 800–807, 1958
Schoen RT, Vender RJ. Mechanisms of non-steroidal anti-inflammatory drug induced gastric damage. American Journal of Medicine 86: 449–456, 1989
Semble EL, Wu WC, Castell DO. Non-steroidal anti-inflammatory drugs and esophageal injury. Seminars in Arthritis and Rheumatism 19: 99–109, 1989
Settipane RA, Chafee FH. Nasal polyps in asthma and rhinitis: a review of 6037 patients. Journal of Allergy and Clinical Immunology 59: 17–21, 1977
Settipane GA, Chafee FH, Klein DE. Aspirin intolerance II: a prospective study in an atopic and normal population. Journal of Allergy and Clinical Immunology 53: 200–204, 1974
Settipane RA, Stevenson DD. Cross sensitivity with acetaminophen in ASA-sensitive asthmatics. Abstract No. 47. Journal of Allergy and Clinical Immunology 81: 180, 1988
Somerville KW, Faulkner G, Langman MJS. Non-steroidal anti-inflammatory drugs and bleeding peptic ulcer. Lancet 1: 462–464, 1985
Spector SL, Wangaard CH, Farr RS. Aspirin and concomitant idiosyncrasies in adult asthmatic patients. Journal of Allergy and Clinical Immunology 64: 500–506, 1979
Stevenson DD. Diagnosis, prevention, and treatment of adverse reactions to aspirin and non-steroidal anti-inflammatory drugs. Journal of Allergy and Clinical Immunology 74: 617–622, 1984
Stevenson DD, Schrank PJ, Hougham AJ, Goldlust MB, Wilson RR. Salsalate cross sensitivity in aspirin sensitive asthmatics. Abstract No. 49. Journal of Allergy and Clinical Immunology 81: 181, 1988
Szabo S, Spill WF, Rainsford KD. Non-steroidal anti-inflammatory drug induced gastropathy: mechanisms and management. Medical Toxicology and Adverse Drug Experience 4: 77–94, 1989
Szczeklik A, Gryglewski RJ, Czerniawska-Mysik G. Relationship of inhibition of prostaglandin biosynthesis by analysis of asthma attacks in aspirin sensitive patients. British Medical Journal 1: 67–69, 1975
Szczeklik A, Gryglewski RJ, Czerniawska-Mysik G. Clinical patterns of hypersensitivity to non-steroidal anti-inflammatory drugs and their pathogenesis. Journal of Allergy and Clinical Immunology 60: 276–284, 1977
Tenney SM, Miller RM. The respiratory and circulating actions of salicylate. American Journal of Medicine 19: 498–508, 1955
Wallace S, Whiting B, Runcie J. Factors affecting drug binding in plasma of elderly patients. British Journal of Clinical Pharmacology 3: 327–330, 1976
Warren RP. Effect of aspirin in chronic urticaria. British Journal of Dermatology 72: 350–354, 1960
Weber RW, Hoffman M, Raines DA, Nelson HS. Incidence of bronchoconstriction due to aspirin, azo dyes, non-azo dyes, and preservatives in a population of perennial asthmatics. Journal of Allergy and Clinical Immunology 64: 32–37, 1979
Woodford-Williams E, Alvares AS, Webster D, Landless B, Dixon MP. Serum protein patterns in ‘normal’ and pathological ageing. Gerontologia 10: 86–99, 1964
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Karsh, J. Adverse Reactions and Interactions with Aspirin. Drug-Safety 5, 317–327 (1990). https://doi.org/10.2165/00002018-199005050-00002
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DOI: https://doi.org/10.2165/00002018-199005050-00002