Old reliable: More than a century later, we still turn to aspirin

Dr. Philip Majerus discovered a few decades ago that aspirin can help prevent heart attacks and stroke. Since then, Majerus, a professor at Washington University in St. Louis, has maintained a deep respect for this little white pill, which has been around since the 1800s. “Aspirin is the most effective drug that we have,” Majerus says. “If we eliminated all but three drugs, aspirin would be one” we should keep, he says. Much of America agrees with him. Aspirin is in virtually everyone’s medicine cabinet.

Doctors still like it because, while there’s a pill for every ailment aspirin addresses, aspirin is the only pill that takes care of so many conditions. Consumers still like it because it’s the least expensive and most versatile drug on the market.

“To the consumer, it is almost a miracle drug,” says Nimita Thekkepat, assistant professor of pharmacy at St. Louis College of Pharmacy. “It helps inflammation, fever, and it can save your life (from heart attack).”

The mystery

Aspirin works by blocking the production of prostaglandins, the on-off switch in cells that regulate pain and inflammation, among other things.

That’s why aspirin stops mild inflammation and pain. But that’s the blessing and the curse.

Prostaglandins are unique to each family of cells. Some versions are good; some versions promote pain; some versions constrict blood vessels and help platelets clot.

But to aspirin, the only good prostaglandin is a dead prostaglandin.

So while it blocks prostaglandins that cause pain or cause clotting and narrowing of the blood vessels and inflammation, it also blocks prostaglandins that protect the stomach lining.

That’s where stomach bleeding comes from when you take aspirin or other drugs in the aspirin family.

They’re known as nonsteroidal anti-inflammatory drugs, or NSAIDs. Drugs in this family include ibuprofen (Motrin, Advil), naproxen (Aleve) and ketoprofen (Orudis). Aspirin causes the most irritation.

“Aspirin is the most toxic (painkiller) to the stomach,” says Dr. Richard Brasington, head of the Division of Rheumatology at Washington University School of Medicine.

Still, the versatility of aspirin allows a range of dosages for physical problems.

For example, a very low dose – one pill of 81 milligrams compared with two pills of 325 milligrams for a full dose – will protect your cardiovascular system by preventing blood clots and relaxing constricted blood vessels, but it rarely upsets the stomach.

“Remember that the low-dose aspirin for (cardiovascular health) is a completely different drug than taking 20 aspirin a day for pain,” Brasington says.

Majerus agreed: “The effect on platelets is long-lasting at such a low dose that it doesn’t affect anything else.”

Counteracting problems

Some would consider aspirin semiretired as a pain reliever.

Sexier over-the-counter and prescription painkillers have eclipsed aspirin as the frontline pain remedy.

They’re more powerful and longer-lasting. Prescription drugs do wonders for blood pressure and heart disease.

But while there’s a better drug for anything aspirin can do, no drug can do everything aspirin can do.

“I think of it more as an anti-platelet,” Thekkepat says. “I don’t think of it as much as a (painkiller).

“It’s a good anti-inflammatory agent, but we have other drugs out there for that. I think it has to create anti-platelet effects.”

Still, it has some advantages.

Brasington named a few:

“Expense. Patients with lower incomes can buy big jars of aspirin at discount stores and, under a doctor’s care, take as many as two dozen a day for pain relief.

“Versatility. Many people who suffer from long-term pain are older. So taking aspirin for pain also will help protect the cardiovascular system from heart attacks and strokes caused by clotting.

“It’s chewable. Aspirin can be chewed and swallowed. Or pills can be dissolved in water and consumed, a big plus for people who have trouble swallowing pills.

“It can save lives. In the event of a heart attack, chew two aspirin, and the effect of easing the effect of a blood clot is almost immediate, doctors say. No other nonprescription drug can do that.

“I tell my students to always keep a small package of aspirin,” Thekkapat says. “If you’re out somewhere or on an airplane and someone calls for medical help, this may give them a little more time to get to a hospital.”

Physicians suggest that if you have stomach problems with aspirin, either take a coated aspirin such as Ecotrin, a buffered aspirin such as Bufferin or talk to your doctor to find a painkiller that’s directed at your specific pain.

Taking an antacid won’t prevent stomach problems.

Drug wars

Don’t take different nonsteroidal anti-inflammatory drugs at the same time, experts warn.

They neutralize each other so that neither works well.

And that would include aspirin’s prevention of clotting.

The remedy, experts say, is to wait several hours between taking one drug and taking the next.

Physicians and pharmacists say to separate your aspirin dose by eight to 12 hours, and you’ll get the benefit of both drugs.

“Simply take the painkiller in the morning and the aspirin in the evening,” Brasington says.