Aspirin

[BertiWooster]

There was a recent report about the benefits of taking 75mg of aspirin on a daily basis .

However , i beleive that some experts are warning about the danger of taking aspirin - internal bleeding etc .

So what does one do - take it or not ?

[Sqad]

jomifl....I cant answer your question and as you see, I have posed the same question to the prof who is an academic. One presumes that they have set up properly conducted trials to assay the blood salicylate levels with one group taking aspirin with milk and the other group without it....i,e is the milk inhibiting the absorption of the aspirin.

[BertiWooster]

Hi again Prof

The information for Mrs Prof is as follows -

PFO closed - May 2006
Atorvastatin
Age - 51

Other drugs

Modified Release Verapamil Hydrochloride - 240mg
Doxazosin - 4mg
Aspirin - Enteric Coated - 75mg
Lisinopril & Hydrochlorothiaazide - 20mg +12.5mg
Lansoprazole ( when required ) 30mg
Fluorometholone 0.01% - eye drops


Also , is it still recomended to drink milk , even if the aspirin being taken is Enteric coated ?

[BertiWooster]

oops - corrections

- Hydrochlorothiaazide ( should be spelt with one 'a' )

Fluorometholone 0.01% - eye drops ( should be 0.1% )

[anneasquith]

i agree very much with waldo on this point of medical advice, diagnosis,and drug treatment, given on AB. with no disrespect to any professional who gives advice, i have stated in the past and will repeat myself,its a very brave person who gives advice IMO , i am a brain surgeon with 40 years experience but dont advertise the fact?

[honky-tonk]

if Asprin is easier on the stomach lining taken with milk why does it not state that on the Patient Information Leaflet. Taken on a daily basis prescribed from GP would be Dispersible Asprin, the tablet is dispersed in a glass of water either befor food or after. I did read somewhere that taking asprin late of an evening helps lower high blood pressure. correct me i am wrong

[theprof]

Sqad, I'd be the first to agree that aspirin usage in the walking-well remains controversial. Nevertheless, there is currently a growing tide of health professionals who feel that the benefits of aspirin, particularly in the over 50's, outweigh the risks. Peter Rothwell, is one such advocate of preventative aspirin therapy:

http://www.ox.ac.uk/m...ries/2010/101207.html

The data provided in the original Lancet article makes fascinating reading and does not confine itself to the therapeutic benefits of aspirin in the treatment of cancers alone. Elsevier have recently tightened up access to the online version of The Lancet and the URL of the article in my browser is currently showing my .ac identifier. Because of this, I'm afraid I can't post a direct link to the article, but I'm sure you can access it.

Nevertheless, both I and MrsProf agree with you and consider that far more research needs to be conducted in this area. The risk of stomach erosion and bleeding remains an issue that should be at the forefont of the medical practitioners mind prior to prescribing but regretfully, historical evidence tends to indicate the contrary. Incidentally, the general opinion of the researchers is indeed that aspirin should be taken by everybody.

I agree entirely with over aspirin and CVA's. MrsProf tells me that there are an increasing number of documented cases coming to light regarding the matter and she has a colleague who is currently supervising a research group investigating this very issue. Similar studies are currently being undertaken in three other medical schools in the UK right now.

Many studies have been conducted over the years regarding aspirin absorption through the stomach lumen, yet it's known that most absorption occurs in the small and large intesti

[theprof]

and large intestine. The benefits of lining the stomach with milk may therefore be futile although there does seem to be a scarcity of trials published papers on blood salicylate levels in groups taking aspirin with milk.. Nevertheless, it may be worth a try.

[theprof]

honky-tonk, the PIL will never recommend the ingestion of milk prior to aspirin due to those patients who are lactose intolerant and there's a lot of them about as they say.

[honky-tonk]

But Asprin contains Lactose

[rabbitygirl]

No one has mentioned the matter of taking any medication with food. I've always believed it better to take meds with or after food, either to buffer or because the med can make you constipated. Unless the med box states before food. Surely milk is an example of what you can use as a buffer? Btw, I recently saw a tiny article either in the Mail or Times that taking low dose Aspirin somehow enables the body to absorb more calcium which could help a little in keeping bones stronger.

[theprof]

jomifl, aspirin is absorbed by passive diffusion in the intestine. The pH in the upper duodenum is around 2 and most absorption takes place in this area. The pH in the colon is around 8 and yes, aspirin would be neutralised at this pH, but the reality is that hardly any non-ionised aspirin reaches the colon.

Due to the intestinal absorbtion, aspirin works in patients who have undergone full surgical gastrectomy which is in many ways ironic as far as side-effects are concerned.

[theprof]

honky-tonk, yes but it's a negligible amount. Milk contains far more.

[society]

I’d advise anyone taking aspirin or decide to take aspirin without the guidance of a doctor don’t do it. I once did on my own and noticed that my eyes always became bloody after taking it.

[theprof]

BertiWooster, Sqad is correct in that I am indeed an academic although I currently hold chairs in various privatised and government research laboratories in the UK. I even hold a senior military rank in order to work at these establishments which really tickles MrsProf. It's a shame the BBC declined to use it during an interview I did last week.

Anyway, that's enough about me. What I wanted to say was that I'm not really in a position to discuss clinical issues or drug regimes. The questions I asked last night were questions asked by MrsProf after she read your post and while she is eminently qualified to advise on the drug regime, I doubt she would do so without seeing the patient.

I think that you will be far better off following the advice of the patient's own medical advisers.

[Sqad]

the Prof....excellent answers and I follow CV research in the future with interest.

How do you stay up so late at night, particularly in dealing with AB?.....LOL

[heathfield]

I remember the problem of aspirin causing bleeding being discussed many years ago. It was considered then that, since aspirin crystals are exceptionally sharp little beasties, that this was the obvious cause of the bleeding. Bayer went to the length of producing aspirin where they claimed to have rounded off the crystals. I can't find a reference to this on the web, but I remember the packaging distinctly, with an illustration that looked like grains of corn with sharp ends, (before), and similar grains with rounded ends, (after). Compare that to some of the images here...

http://www.google.co....num=1&ved=0CCcQsAQwAA

I remember, too, when 'Soluble Aspirin' came on the market. That label was withdrawn pretty quickly when a chorus of 'Oh no it isn't!' went up. The word 'Soluble' was replaced by the present term, 'Dispersable'. This simply means that the tablet breaks down in water, though the aspirin itself isn't dissolving.

The idea that acid from aspirin erodes the stomach is new to me - I hadn't heard about that before reading it here. Perhaps the fats in milk act as a lubricant to help prevent scoring of the stomach by those crystals?

[Sqad]

Heathfield......a good resume of the history of aspirin.....are you a pharmacist by any chance? ;-)

I agree with all you say about the protective element of milk for the stomach, but many if not most of the gastro intestinal bleeds due to aspirin are in the small bowel......some 20feet away from the stomach, surely out of the protection of the milk?

[douglas9401]

A wee light went on in my head after reading Heathfield's comment. The ad used to say "It's a soluble aspirin, the sort doctors prefer".
Who says commercials don't work? That must have been decades ago. :)

[theprof]

Sqad, I've been burning the midnight oil since my student days I'm afraid. Many years ago I had a chemistry tutor who told me that his method of absorbing information was to go over all the notes he had made during lectures that day after returning to his student digs. I gave it a try and soon thought nothing of staying up until 2am. While it knackered my uni social life I've been a night bird ever since! The funny thing is that he ended up a prof as well!

I had a lie-in this morning as I'm advising on a project in one of the institutions I mentioned in Kent today and I didn't need to get here until 11am. I'm leaving for home shortly and ironically, I'll be back home earlier than I would be if I was in uni!

There are times when The Answerbank can be very challenging and I don't always get it right. I've found that providing technical explanations that are read by everyone from someone who might have left school with no qualifications to those in academia has it's difficulties at times. You can reach a point where an over simplification only raises more questions. I think the fact that I take a few days out from uni annually to teach biology and chemistry classes in schools has given me a valuable insight into the matter over the years. My kids had a hell of a time during their schooldays!

[Sqad]

the prof.......I never let academia interrupt my social life at Med School.....that is probably why I didnt end up as a prof LOL