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ASA (Acetylsalicylic Acid) – Effects & Uses

ASA (acetylsalicylic acid) is a widely used pain reliever, fever reducer, and blood thinner commonly prescribed to prevent heart attacks and strokes.

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Things worth knowing about "ASA"

ASA (acetylsalicylic acid) is a widely used pain reliever, fever reducer, and blood thinner commonly prescribed to prevent heart attacks and strokes.

What is ASA (Acetylsalicylic Acid)?

ASA stands for acetylsalicylic acid and is one of the oldest and most widely used active pharmaceutical ingredients in medicine. It belongs to the group of non-steroidal anti-inflammatory drugs (NSAIDs) and exerts simultaneous analgesic (pain-relieving), antipyretic (fever-reducing), anti-inflammatory, and antithrombotic (blood-thinning) effects. ASA is globally recognized under the brand name Aspirin.

Indications – When is ASA Used?

ASA is used at different dosages for various medical purposes:

Pain relief: Headaches, toothaches, muscle pain, and mild to moderate pain in general.
Fever reduction: For elevated body temperature during infectious illnesses. Note: ASA is contraindicated in children and adolescents under 16 years of age due to the risk of Reye syndrome.
Anti-inflammatory treatment: For inflammatory rheumatic conditions.
Prevention of heart attack and stroke: In low doses (75-100 mg daily) to inhibit platelet aggregation in patients with elevated cardiovascular risk.
Acute therapy: ASA is frequently administered as an emergency measure when a heart attack is suspected.

Mechanism of Action

ASA irreversibly inhibits the enzyme cyclooxygenase (COX-1 and COX-2). This enzyme is responsible for the production of prostaglandins and thromboxane A2:

Prostaglandins are signaling molecules that mediate pain, inflammation, and fever. By inhibiting their synthesis, ASA reduces pain and inflammation.
Thromboxane A2 promotes platelet aggregation (clumping of blood platelets). Inhibiting this substance prevents blood clot formation, resulting in a blood-thinning effect.

Because the inhibition by ASA is irreversible, the antiplatelet effect persists for the entire lifespan of the platelets (approximately 7-10 days).

Dosage

The dosage of ASA depends on the intended use:

Pain and fever: 500-1000 mg per dose, up to a maximum of 3 g per day.
Cardiovascular prevention (antiplatelet therapy): 75-100 mg daily as a long-term treatment.

The exact dosage should always be determined in consultation with a qualified healthcare professional.

Side Effects

Like all medications, ASA can cause side effects. The most common and clinically significant include:

Gastrointestinal problems: Stomach pain, nausea, heartburn, and in severe cases gastrointestinal bleeding, as ASA can damage the protective stomach lining.
Increased bleeding tendency: The blood-thinning effect prolongs bleeding time.
Allergic reactions: Skin rashes, asthma attacks (especially in patients with analgesic-induced asthma).
Reye syndrome: A rare but serious condition affecting the liver and brain that can occur in children and adolescents under 16 years of age following ASA use.
Tinnitus and hearing loss: At very high doses (salicylism).

Contraindications – When Should ASA Not Be Taken?

Known hypersensitivity to salicylates or other NSAIDs.
Active peptic ulcers or gastrointestinal bleeding.
Severe liver or kidney insufficiency.
Children and adolescents under 16 years of age (except in specific medical indications).
Last trimester of pregnancy.
Concomitant use of anticoagulants (e.g., warfarin) -- only under medical supervision.

Drug Interactions

ASA can interact with various medications:

Anticoagulants (e.g., warfarin, heparin): Increased risk of bleeding.
Other NSAIDs (e.g., ibuprofen): Enhanced side effects and potential reduction of the cardioprotective effect of ASA.
Methotrexate: ASA may increase the toxicity of methotrexate.
Antidiabetic agents: ASA may enhance the blood glucose-lowering effect.

References

Rang H.P., Dale M.M., Ritter J.M. et al. - Rang and Dale's Pharmacology. 9th Edition. Elsevier, 2019.
European Medicines Agency (EMA) - Product Information for Acetylsalicylic Acid. Available at: www.ema.europa.eu
World Health Organization (WHO) - Model List of Essential Medicines, 23rd Edition. Geneva: WHO, 2023.

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