ASPIRIN, IBUPROFEN, AND CLOTTING
Question: Is there any difference between aspirin and ibuprofen in their tendency to inhibit the blood-clotting action of platelets?
Answer: Yes—though it’s a difference in degree. A daily dose of three 200-milligram ibuprofen tablets (Advil, Motrin-IB) can inhibit platelet function for about 24 hours. It takes only about one-third of a single 325-milligram aspirin tablet to inhibit platelets for up to a week. While people with bleeding disorders must avoid aspirin, they may be able to use ibuprofen under a doctor’s supervision.
ASPIRIN AND HEARING
Question: I frequently take aspirin and have lately begun to wonder if it affects my hearing. Can it?
Answer: Yes. Hearing loss and tinnitus (ringing in the ears) have been recognized for more than a century as signs of aspirin toxicity. When those problems are caused by too much aspirin, both problems disappear on reducing the aspirin dosage. If either problem persists, check with your physician.
ASPIRIN GONE BAD
Question: I have always heard that you should discard aspirin when it begins to smell like vinegar. The last bottle I bought has an expiration date of two years from now, but it already has that vinegary odor. Is such aspirin harmful?
Answer: No, just less effective. The odor indicates that the drug is breaking down into its constituent parts. That happens gradually but begins as soon as you first open the bottle. Even fresh aspirin has some vinegary smell. But if the odor is very strong in a previously unopened bottle, replace it. To slow the decomposition, store aspirin in a cool, dry place (not the bathroom) and keep the cap tightly closed.
HOW MUCH ASPIRIN?
Question: My neurologist has prescribed a daily 81-milligram aspirin tablet to prevent stroke. Would a higher dose be more effective?
Answer: It’s unlikely but not certain. While some studies demonstrating protection against stroke have used as much as 1,800 milligrams of aspirin a day, none has shown any added benefit over daily doses as low as 50 to 100 milligrams. The hood and Drug Administration recently endorsed a range of 50 milligrams to no more than 325 milligrams (the amount in an ordinary, regular-strength aspirin tablet) for people who are at risk for a thrombotic (clot-related) stroke or a heart attack. The lower the dose, the lower the chance of side effects, which can include heartburn and stomach bleeding. Because of the possible adverse effects, it’s essential to consult a physician before starting an aspirin regimen—whatever the dose.
ASPIRIN AND HERBAL BLOOD THINNERS
Question: I know that taking a baby aspirin each day can help prevent blood clots in the arteries. I’ve also heard many people recommend garlic capsules, ginger tea, and ginkgo biloba for that purpose. Which strategy is better? Or would it be OK to take both aspirin and the herbs?
Answer: The three herbs you mention do appear to have some anticlotting effect, but only aspirin has been shown to help reduce the risk of heart attack and clot-related stroke. Moreover, because aspirin is such a potent blood thinner, even a low-dose “baby” aspirin might interact with any of those herbs and pose a possible risk of bleeding problems.
PAIN IN THE NECK
Question: When I walk uphill rapidly, I get a slight pain in the left side of my neck. My doctor ordered a treadmill test, which showed nothing abnormal. I’m 60 years old. What could the pain be?
Answer: There are two main possibilities: One is simple arthritic or muscular pain. If holding your head in certain positions sparks the pain, the problem might well be musculoskeletal.
Or it could be an atypical form of angina pectoris, a symptom of insufficient blood circulation to the heart. The pain is usually centered in the chest but may sometimes be felt only in the neck.
If physical exertion triggers the pain, coronary heart disease must be suspected. That’s why your doctor tested you on a treadmill—to see whether the exercise would either provoke the pain or reveal evidence of inadequate circulation on an electrocardiogram.
Unfortunately, a normal result on a standard treadmill stress test does not necessarily exclude coronary disease. To rule that out more definitively, you may need a nuclear stress test, in which a radioactive chemical is injected into the bloodstream during exercise and the heart is scanned by a radiation detector. If the nuclear test shows an abnormality, then angiography may be necessary.
Question: I have trigeminal neuralgia, which causes excruciating pain on one side of my face. The drug Tegretol eliminates the pain but leaves me confused, drowsy, and depressed. Is there any alternative treatment?
Answer: To start with, your physician may be able to reduce your dosage of carbamazepine (Tegretol) without compromising the drug’s effectiveness. If that doesn’t work, your physician might try other drugs, such as baclofen (Lioresal), pheny-toin (Dilantin), amitriptyline (Elavil), or gabapentin (Neurontin).
It’s also possible to deaden the particular nerve that’s causing the pain, using alcohol or glycerol injections, nerve blocks, radio frequency waves through the skin, or surgery. However, those procedures can leave part of your face permanently numb.
ANTI-INFLAMMATORY SIDE EFFECTS
Question: I have a gnawing ache in my left thigh, diagnosed as pressure on a nerve from a bulging vertebral disk. My doctor prescribed Feldene, which helps. But will I have trouble with side effects if I keep using it?
Answer: Perhaps. About 30 percent of patients who take pirox-icam (Feldene) report adverse effects—most often gastrointestinal complaints, such as upset stomach, nausea, constipation, diarrhea, or flatulence. Such problems force about S percent of users to stop taking the drug.
Like aspirin, piroxicam and all other nonsteroidal anti-inflammatory drugs (such as fenoprofen, ibuprofen, and naproxen) can cause slight blood loss in the stool, although it may not be readily visible. Over a period of months, this can cause anemia. A physician should check your blood count every two or three months. People who bleed easily, take anticoagulants, or are sensitive to aspirin should avoid piroxicam.
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