Aspirin gastrointestinal effects

In medical practice, other salicylic acid derivatives are used in the form of salts. Magnesium salicylate and sodium salicylate are less effective than respective doses of aspirin however, they are easier on patients that are sensitive to aspirin. Choline magnesium trisalicylate represents a mixture of choline salicylate and magnesium salicylate, which has the same effect as aspirin however, it is easier on patients in which gastrointestinal effects are observed upon taking aspirin. 

Adverse effects. Gastrointestinal effects are those of NSAIDs in general. Effects particularly associated with aspirin are ... 

Aspirin can also play a role in esophageal bleeding, ulceration, or benign stricture, and it should be considered as a possible cause in patients, particularly the elderly, who present with any of these features. There have also been reports of rectal stricture in the elderly, associated with the use of aspirin suppositories. Effects on both these strictures emphasize the significance of a direct local action of aspirin as well as a systemic action and underlines the relevance of the involvement of oxygen-derived free radicals in the pathogenesis of mucosal lesions in the gastrointestinal tract (54-56). 

The pattern of adverse effects is similar to that of piroxicam, but tenoxicam causes slightly fewer serious gastrointestinal effects (1). Fecal blood loss is lower than with aspirin (SEDA-8, 111). A large, multicenter, hospital-based study confirmed that tenoxicam and piroxicam had similar tolerance ratings 13% of patients had severe adverse effects, most often gastrointestinal (melena, hematemesis, rectal bleeding, exacerbation of ulcerative colitis) and serious rashes (SEDA-15, 103). 

A case report described acute ulcerative colitis in a woman taking ro-fecoxib 25 mg daily who also took aspirin. See also gastrointestinal effects, in NSAIDs + Aspirin Antiplatelet dose , p.l44. 

Plasma digoxin levels may decrease when the drug is administered with bleomycin. When bleomycin is used witii cisplatin, there is an increased risk of bleomycin toxicity Pulmonary toxicity may occur when bleomycin is administered with other antineoplastic drugs. Plicamycin, mitomycin, mitoxantrone, and dactino-mycin have an additive bone marrow depressant effect when administered with other antineoplastic drugs. In addition, mitomycin, mitoxantrone, and dactinomycin decrease antibody response to live virus vaccines. Dactinomycin potentiates or reactivates skin or gastrointestinal reactions of radiation therapy There is an increased risk of bleeding when plicamycin is administered witii aspirin, warfarin, heparin, and the NSAIDs. 

Yamashita reported anti-inflammatory effect of astaxanthin when administered with aspirin. An oral preparation has been developed by Alejung and Wadstroem for the treatment of Helicobacter infections of the mammalian gastrointestinal tract. Strong evidence suggested that astaxanthin modulated the humoral and non-humoral immune systems. It enhanced the release of interleukin-1 and tumor necrosis factor-... 

Other activities on the gastrointestinal system included antidiarrhoeal and gastroprotective effects. Satureja hortensis and Aloysia triphylla EOs inhibited castor oil induced diarrhoea in rodents [225, 255]. The EO of lavender and its components (linalool, linalyl acetate) and the EO of Cryptomeria japonica (ter-pin-4-ol and elemol) showed protective activities against acute ethanol/aspirin-induced gastric ulcers in rodents [200,254]. 

Overview analyses have shown that low-dose aspirin reduces the secondary incidence of heart attack and stroke by about 25%. However, it elevates the low risk of serious gastrointestinal bleeding about twofold over placebo. Low-dose aspirin also reduces the incidence of first myocardial infarction. However, in this case, the benefit versus risk of gastrointestinal bleeding is less clear. The effects of aspirin on platelet function are discussed in greater detail in Chapter 34. 

Selectivity for COX-1 versus COX-2 is variable and incomplete for the older NSAIDs, but many selective COX-2 inhibitors have been synthesized. The selective COX-2 inhibitors do not affect platelet function at their usual doses. In testing using human whole blood, aspirin, ibuprofen, indomethacin, piroxicam, and sulindac are somewhat more effective in inhibiting COX-1. The efficacy of -2-selective drugs equals that of the older NSAIDs, while gastrointestinal safety may be improved. On the other hand, selective COX-2 inhibitors may increase the incidence of edema and hypertension. As of December 2008, celecoxib and the less selective meloxicam are the only COX-2 inhibitors marketed in the USA. Rofecoxib and valdecoxib, two previously marketed, selective COX-2 inhibitors, have been withdrawn from the market due to their association with increased cardiovascular thrombotic events. Celecoxib has an FDA-initiated "black box" warning concerning cardiovascular risks. It has been recommended that all NSAID product labels be revised to include cardiovascular risks. 

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