Acetylsalicylic acid

Although the name is a tongue twister, but the drug has star quality: acetylsalicylic acid (ASA). Whether it's a headache, a toothache, a fever or a hangover after a night of sleep - almost everyone has helped ASS before. As early as 1850, this little brother of salicylic acid was first produced by the French chemist Charles Frederick Gerhardt. However, it was reserved for the German chemists Felix Hoffmann and Heinrich Dreser to help the painkilling substance to make a decisive breakthrough.

ASA became aspirin®

Although the alleviating effect of the substance had been recognized early on, its side effects were devastating. Ingestion led to chemical burns of the mouth and stomach mucous membranes - a problem that was eliminated by the young Bayer chemists Hoffmann and Dreser and henceforth presented in powder form.

Two years later, in 1899, the drug became aspirin® born of Bayer, which has become synonymous with painkillers in general.

ASA: one active ingredient - many effects

The active substance Acetylsalicylsacid, in short ASS called, is now widely used. In addition to the analgesic effect, researchers have found that the drug can be used to prevent circulatory disorders in the vascular system of the heart and brain.

Acetylsalicylic acid reduces the occurrence of thrombosis in the blood vessels, thus counteracting clumping of platelets. Therefore, the preparation is used inter alia before long air travel to prevent travel thrombosis.

Another application of ASA is the anti-inflammatory. Therefore, the drug can be used in rheumatism and arthritis. However, it must be dosed for much higher and accordingly can lead to increased side effects such as bleeding in the gastrointestinal tract.

Finally, the effectiveness against cataract is based on the fact that acetylsalicylic acid destroys those protein molecules that make the eyeball cloudy.

Preventive use of ASA

In 1985, ASA was approved in the US for emergency medicine in acute myocardial infarction. In 1988, an American study with 22,000 people made headlines: The daily intake of aspirin in healthy people should reduce the risk of heart attack by 44 percent, said in a study of the American Heart Association. This was the beginning of aspirin as a "preventive medicine", but its use has to be individually coordinated.

Because the preventive use of ASA is very controversial. To give healthy people daily medication over a period of several years, even if low-dose, may have negative consequences in view of the side effects. The risk of being harmed by the side effects is not to be ignored with such a permanent intake.

ASA has been shown to have a preventive effect against various cancers of the digestive tract, such as colon cancer or esophageal cancer. But even in this context, the precautionary intake over several years due to the risk of internal bleeding is controversial.

Dosage of acetylsalicylic acid

The maximum amount per day should not exceed three grams - equivalent to six 500 milligram tablets. A single dose of ten grams is life threatening, because then the blood gets too acidic. This will speed up breathing and boost kidney activity, which can result in dangerous fluid loss. Then it can lead to tissue destruction and ultimately death.

The commercial doses in the form of tablets contain 500 milligrams of active ingredient in effervescent tablets, the dosage of 400 milligrams is slightly lower. Chewable tablets, which are only recently on the market, are taken without water and can therefore be easily taken.

Acetylsalicylic acid in combination with caffeine and vitamin C.

In addition, ASA preparations are offered in combination with other drugs, such as caffeine, since it has been known that caffeine enhances the effects of ASA.

Also as a combined preparation with vitamin C, the active ingredient has a positive effect on the immune system of the body.

4 facts about ASA - © istockphoto, Andrei_Andreev

Risks and side effects of ASA

Acetylsalicylic acid also has its disadvantages. Sensitive people respond with irritation, heartburn, and rarely bleeding from the stomach and intestinal mucosa. Taking higher doses of ASA increases the risk of major bleeding considerably.

In rare cases, iron deficiency anemia can even occur because the iron bound in the red blood pigment is lost due to the bleeding in the stomach. This aspect is important because acetylsalicylic acid is not a prescription drug, so aspirin® and the corresponding preparations from other manufacturers are readily available for sale. Control over a possible incorrect dosage is therefore difficult.

People who take ASA on a regular basis without the instruction of their doctor should keep an intake diary and discuss this with their doctor or pharmacist.

Consequences of long-term use of ASA

Long-term use of ASA may also cause the following side effects:

  • dizziness
  • nausea
  • limited hearing
  • blurred vision
  • tinnitus

However, these side effects disappear when the dose is reduced or the drug is completely discontinued.

Allergy to ASA

Also allergic reactions in the form of skin rashes or respiratory tract cramps have been observed. The so-called "Aspirin asthma" meets particularly pre-loaded patients who respond to the drug with asthma-like airway cramps.

ASS: Not suitable for children

Children and adolescents with fever and pain should not take acetylsalicylic acid. Especially in connection with viral infections, it can be life-threatening Reye's syndrome come, can be severely damaged in the brain and liver. The disease itself is not treatable, the therapy is limited to the treatment of the symptoms: the liver function is supported and one tries to lower the increased intracranial pressure by medication.

The exact triggers for this serious, non-infectious disease are not yet known. Researchers assume, among other things, a genetic predisposition. For children and adolescents, however, there are a number of well-tolerated remedies such as paracetamol, which can be used in pain and to reduce fever.

Do not use ASA during pregnancy

Acetylsalicylic acid should only be taken in the first five months of pregnancy after consultation with a doctor. From the beginning of the sixth month of pregnancy, ASA should no longer be used as it may cause serious damage to the mother or child. Another alternative painkiller is paracetamol.

Also during the lactation It is recommended to refrain from ASA as a precaution, as the active substance can pass into breast milk.

Other contraindications of ASS

The active substance may not be administered in addition to:

  • Hypersensitivity to acetylsalicylic acid or other salicylates
  • acute gastric or intestinal ulcers
  • increased bleeding tendency
  • Liver and kidney failure
  • Heart failure
  • Taking methotrexate

New ways for acetylsalicylic acid

How diverse the active substance can be used has already been shown in recent years. In 2004, the European Commission granted Bayer HealthCare AG the "Orphan Drug Status" for acetylsalicylic acid for the treatment of Polycythemia vera granted. In this very rare disease, the blood cells multiply uncontrollably. Patients therefore suffer from circulatory disorders and vascular occlusions, as well as premature heart attacks or strokes.

The ability of acetylsalicylic acid to inhibit clumping of platelets significantly reduces the risk of heart attack or stroke. In its decision, the Commission confirms that the additional treatment with aspirin®Acetylsalicylic acid (ASA) significantly reduces the risk of patients having a heart attack or stroke.

Orphan drug status can be granted for diseases that are so rare that extensive clinical trials, as mandated in medicine, are often not possible. In order to give greater medical attention to these - as in polycythemia vera - often life-threatening illnesses (orphan = "orphan"), the orphan drug status ensures the manufacturers of suitable drugs far-reaching support and regulatory approval.

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