Aspirin and Antiplatelet Medications (cont.)
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Serious side effects of aspirin and other NSAIDs occur infrequently. However, they may occur and generally tend to be more frequent with higher doses. Therefore, it is advisable to use the lowest effective dose to minimize side effects.
The most common side effects of aspirin involve the gastrointestinal system.
Aspirin can cause:
Occasionally, aspirin may be toxic to the liver.
Sometimes, ulcers of the stomach and bleeding occur without any abdominal pain, and the only signs of bleeding may be:
Another serious but rare side effect of aspirin is intracranial hemorrhage (bleeding into the tissues of the brain), similar to a hemorrhagic stroke.
Aspirin can impair function of the kidney and liver, especially in patients who already have liver and kidney disease. Other side effects of aspirin include easy bruising, vertigo, ringing in the ears (tinnitus), and lightheadedness.
Serious side effects of aspirin, such as bleeding ulcers or intracranial bleeding, are rare (less than 1% of patients) among patients taking moderate doses of aspirin (for example, 325 mg/d). Serious side effects of aspirin should be even lower with low doses such as 75-160 mg/d. However, the actual incidence of serious bleeding with long-term use of low dose aspirin has not been clearly determined.
What is aspirin allergy?
Allergy to aspirin is a rare condition in which a patient can develop swelling of tissues, spasm of the airways (bronchospasm) that causes difficulty breathing, and even anaphylaxis, a life-threatening condition. Clearly, patients with a history of allergy to aspirin should not take aspirin. Since aspirin is related chemically to the other NSAIDs, patients who are allergic to the other NSAIDs, such as ibuprofen (Motrin) and naproxen (Aleve), also should not take aspirin.
What interactions might aspirin have with other medications?
Aspirin may interact with other medications and cause undesirable side effects. For example:
What can be done to reduce the risk of ulcers from long-term aspirin use?
Long-term low dose aspirin use is generally safe. An estimated 10% of the patients taking long-term aspirin (75-325 mg/day) can develop ulcers. Most of these ulcers were asymptomatic (no abdominal pain or bleeding). Patients at a higher risk of developing ulcers with low dose aspirin included elderly patients age 70 years and older, and patients with H. pylori stomach infection (see below). The risk of significant ulcer bleeding from aspirin is low (approximately 1%). One can reduce the risk of bleeding by adding a daily dose of a proton pump inhibitor for example, pantoprazole (Protonix), esomeprazole (Nexium), rabeprazole (Aciphex), or lansoprazole (Prevacid, Prevacid SoluTab), and omeprazole (Prilosec, Zegerid).
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