Aspirin constipation with

Derived from the alkaloid thebaine, oxycodone is a highly effective pain-reliever and prescribed to postsurgical patients, cancer patients, and others with severe pain. Oxycodone is sold under various trade names in combination with aspirin, including Per-codan , Endodan, and Roxipirin with acetaminophen it is marketed as Percocet , Endocet, and Roxicet. Oxycodone is also the main ingredient in OxyContin. The most frequent side effect of oxycodone is constipation, but naseua is also common. Oxycodone is highly abused in the United States. 

For example, aspirin should be avoided in patients with ulceration and patients taking anticoagulation medications. It is possible that misuse or overdose of OTC products may develop into many medical problems. For example, improper use of antacids (e.g., aluminum hydroxide) causes constipation. 

There is no clear evidence that any particular dose of aspirin is more effective than others. However, the symptoms of aspirin toxicity, such as dyspepsia and constipation, are dose related, so the smallest effective dose should be used. A starting dosage of 150-300 mg per day is advised for the acute phase of ischemic stroke followed by longterm treatment with 75-150 mg per day. Patients intolerant of aspirin should be treated with clopidogrel if available, or if not with dipyridamole. These newer agents cost significantly more than aspirin. The use of combination antiplatelet therapy is discussed further in Ch. 24. 

Hydrocodone, another codeine congener, is approximately six times more potent than codeine. This agent appears to cause less constipation and less sedation than codeine. It has been suggested that hydrocodone may produce more euphoria than codeine, but this effect has not been substantiated in clinical studies. Hydrocodone is also available in combination with aspirin, acetaminophen, or ibuprofen. 

Analgesics. Opiates can precipitate hepatic encephalopathy in patients with decompensated liver disease. If required to control postoperative pain, doses should be reduced to 25-50% of normal. Constant intravenous infusions should be avoided if the patient is not to be insidiously overdosed. Codeine can precipitate hepatic encephalopathy by its constipating effect alone. Aspirin and other NSAIDs may exacerbate impaired renal function and fluid retention by inhibiting prostaglandin synthesis and may also precipitate gastrointestinal bleeding. 

Adverse effects of zomepirac on the gastrointestinal tract were the most frequent reason for interruption of treatment. They increase with duration of administration. Nausea, vomiting, dyspepsia, discomfort, abdominal pain, and diarrhea or constipation have been recorded, as have stomatitis and tongue pain (4). Zomepirac 300 mg/day increases fecal blood loss, but less than aspirin. 

In patients older than 65 years of age, drugs that correlate most often with constipation are anticholinergics, aspirin, furosemide, ni-... 

A number of aluminium aspirin preparations have also been described, to which different structures have been assigned . One of these compounds, aluminium aspirin NF, was found to be poorly absorbed compared with acetylsalicylic acid. Aloxiprin (Palaprin) is a different form of aluminium aspirin, being a polymeric condensation product of aluminium oxide and acetylsalicylic acid, with the formula Al302(C8H4(o-OCMe)-COO)s 9B. This compound is therapeutically as effective as acetylsalicylic acid it produces less gastric irritation and gastro-intestinal blood loss, but has a slight tendency to cause constipation. ... 

Caution Codeine doses above 65 mg often are not appropriate due to diminishing incremental analgesia with increasing doses but continually increasing constipation and other side effects. Caution Doses of aspirin and acetaminophen in combination opioid/NSAID preparations must also be adjusted to die patient s body weight. Maximum acetaminophen dose 4 gm/day in adults,... 

The most common side effects of hydrocodone include CNS reactions (dizziness, lightheadedness, sedation) and GI disturbances (nausea and vomiting), both of which can be exacerbated in ambulatory versus recumbent patients and possibly ameliorated by adopting the supine position. Other adverse reactions include constipation, urinary retention, dysphoria and/or euphoria, rash, and pruritus. Patients should also be advised that the use of hydrocodone may impair the performance of certain daily activities that require increased physical coordination or mental acuity, such as driving or operating machinery. Because hydrocodone is only available in commercial preparations combining it with other medications, such as aspirin, ibuprofen, or acetominophen, observation of the precautions associated with those adjunct agents is obviously also warranted. 

Although opioid dose requirements are reduced with short-term use of NSAIDs including naproxen, it remains unclear whether reductions in dose are associated with a decrease in opioid-related adverse events such as nausea, vomiting, and constipation. Like other nonselective NSAIDs, naproxen is often withheld in the peri-operative period for fear of surgical site and GI bleeding. It should be appreciated that unlike aspirin, inhibition of platelet aggregation with naproxen is reversible, and temporally related to serum drug concentration. 

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