Although the name is a tongue twister, but the drug has star quality: acetylsalicylic acid (ASA). Whether it's a headache, a toothache, a fever or a hangover after a night out - almost everyone has helped ASS before. As early as 1850, this little brother of salicylic acid was made for the first time by the French chemist Charles Frederick Gerhardt. However, it was reserved for the German chemists Felix Hoffmann and Heinrich Dreser to help the painkilling substance to make a decisive breakthrough.
ASS became Aspirin ®
Although the alleviating effect of the substance had been recognized early on, its side effects were devastating. Ingestion led to chemical burns of the mouth and gastric mucosa - a problem that was eliminated by the young Bayer chemists Hoffmann and Dreser and henceforth presented in powder form.
Two years later, in 1899, the drug Aspirin® from Bayer was born, which today has become synonymous with painkillers in general.
ASA: one active ingredient - many effects
The active ingredient acetylsalicylic acid, abbreviated ASA, is now widely used. In addition to the analgesic effect, researchers have found that the drug can be used to prevent circulatory disorders in the vascular system of the heart and brain.
Acetylsalicylic acid reduces the occurrence of thrombosis in the blood vessels, thus counteracting clumping of platelets. Therefore, the preparation is used inter alia before long air travel to prevent travel thrombosis.
Another field of application of ASA is the inhibition of inflammation. Therefore, the drug can be used in rheumatism and arthritis. However, it has to be dosed much higher and can accordingly lead to increased side effects such as bleeding in the gastrointestinal tract.
Finally, the effectiveness against cataracts is based on the fact that acetylsalicylic acid destroys those protein molecules that make the eyeball cloudy.
Preventive use of ASA
In 1985, ASA was approved in the US for emergency medicine in acute myocardial infarction. In 1988, an American study with 22, 000 people made headlines: The daily intake of aspirin in healthy people should reduce the risk of heart attack by 44 percent, said in a study of the American Heart Association. This was the beginning of aspirin as a "prevention medicine", but its use has to be individually coordinated.
Because the preventive use of ASA is very controversial. To give healthy people daily medication over a period of several years, even if low-dose, may have negative consequences in view of the side effects. The risk of being harmed by the side effects is not to be ignored in such a permanent intake.
ASA has been shown to have a preventive effect against various cancers of the digestive tract, such as colon cancer or esophageal cancer. But even in this context, the precautionary intake over several years due to the risk of internal bleeding is controversial.
Dosage of acetylsalicylic acid
The maximum amount per day should not exceed four grams. A single dose of ten grams is life-threatening, because then the blood becomes too acidic. It accelerates breathing, boosts kidney activity, which can result in dangerous fluid loss. Then it can lead to tissue destruction and ultimately death.
The commercial doses in the form of tablets contain 500 milligrams of active ingredient in effervescent tablets, the dosage of 400 milligrams is slightly lower. Chewable tablets that are only recently on the market, are taken without water and can therefore be easily taken.
Acetylsalicylic acid in combination with caffeine and vitamin C.
In addition, ASA preparations are offered in combination with other agents, such as caffeine, since it has been known that caffeine enhances the effects of ASA.
Also as a combined preparation with vitamin C, the active ingredient has a positive effect on the immune system of the body.
Risks and side effects of ASA
Acetylsalicylic acid also has its disadvantages. Sensitive people respond with irritation, heartburn and, rarely, bleeding from the stomach and intestinal mucosa. Taking higher doses of ASA increases the risk of major bleeding considerably.
In rare cases, iron deficiency anemia may even occur because iron bound in the red blood pigment is lost due to bleeding in the stomach. This aspect is particularly important because acetylsalicylic acid as an active ingredient is not prescription, so that Aspirin ® and the corresponding preparations from other manufacturers are readily available for sale. Control over a possible incorrect dosage is therefore difficult.
People who take ASA on a regular basis without the instruction of their doctor should keep an intake diary and discuss this with their doctor or pharmacist. Long-term use of ASA may also cause the following side effects:
- limited hearing
- blurred vision
However, these side effects disappear when the dose is reduced or the drug is completely discontinued.
Also, allergic reactions in the form of rashes or respiratory tract cramps have been observed. The so-called "aspirin asthma" triggers particularly pre-stressed patients who react to the drug with asthma-like airway cramps.
ASS: Not suitable for children
Children and adolescents with fever and pain should not take acetylsalicylic acid. Especially in connection with viral infections, it can lead to the life-threatening Reye syndrome, in which the brain and liver can be severely damaged. The disease itself is not treatable, the therapy is limited to the treatment of symptoms: the liver function is supported and it tries to reduce the increased intracranial pressure by medication.
The exact triggers for this serious, non-infectious disease are not yet known. Researchers assume, among other things, a genetic predisposition. For children and adolescents, however, there are a number of well-tolerated remedies such as acetaminophen, which can be used in pain and to reduce fever.
New ways for acetylsalicylic acid
How diverse the active ingredient can be used has already been shown in recent years. The European Commission has now granted Bayer HealthCare AG the "Orphan Drug Status" for acetylsalicylic acid for the treatment of polycythemia vera. In this very rare disease, the blood cells multiply uncontrollably. The patients therefore suffer especially from circulatory disorders and vascular occlusions, to premature heart attacks or strokes.
The ability of acetylsalicylic acid to inhibit clumping of platelets significantly reduces the risk of heart attack or stroke. In its decision, the Commission confirms that the additional treatment with the Aspirin ® active ingredient acetylsalicylic acid (ASA) significantly reduces the risk of patients suffering from a heart attack or stroke.
Orphan drug status can be granted for diseases that are so rare that extensive clinical trials, as prescribed in medicine, are often not possible. In order to give greater medical attention to these - as in polycythemia vera - often life-threatening illnesses (orphan = "orphan"), the orphan drug status ensures far-reaching support and regulatory approval for manufacturers of suitable drugs.