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]

Berti
<<<So the enteric coated aspirin minimises the risk of bleeding in the stomach - is there any risks with it disolving in the intestine ? <<<

Of course, the same risk as when in the stomach and in my opinion the "multiple small bleeds" in the small intestine are more sinister than a single larger bleed in the stomach. But get this in perspective..........the advantages of taking aspirin in cardiovascular compromised patients outweighs the small, but significant problems caused by the bleeds.
The latest pronouncement by reputable medical sources, indicates a suggestion that aspirin taken "routinely", by the "healthy" is advantageous in the fight against cardiovascular disease.....and that is the "rub"

[Sqad]

Berti,,,,oooops!.....your statin question....Atorvastatin is "not the recent model" but is the "best seller"

[theprof]

Atorvastatin was first marketed in 1997 as LIpitor and is one of the most successfully marketed drugs of all time. The marketing techniques used by Pfizer are now a model for new drug introductions throughout the world. As Sqad says, it is now the best-seller but is also the most expensive. Thankfully, this will change shortly in the UK as generic versions of the drug will soon become available.

As far as muscle aches and pains are concerned, these effects occur in around 4% of all (ie not dose related) patients taking Atorvastatin, which is less than some of the older statins.

Returning to the aspirin issue, multiple small bleeds in the small intestine are known in patients taking aspirin as Sqad says, but I agree that these have to put into context and I firmly believe that the advantages of aspirin therapy do outweigh the small risks. Thankfully, MrsProf agrees with me!

[theprof]

Onetoomany, thank you for that. Very useful.

[BertiWooster]

Thanks guys

[starone]

I took prescribed aspirin for years for high blood pressure. Then the group practice I go to decided to stop prescribing aspirin because of the scare, so now I don't take it. I feel I have to have blind faith in my doctors but also recognise it is not an exact science and that new things are always being discovered.

[Wak]

Sqad, is there any difference in the stomach reaction to swallowing a solid Aspirin tablet and taking a soluble/dispersible Aspirin in water??

[boxtops]

(scuse me a minute Berti) Prof, I've just been moved onto Atorvastatin, interesting to hear that it's expensive - but I was moved (as sqad knows) from 40mg simvastatin to 20mg atorvastatin, for that very reason, acute muscle pains in my arms. I'm having a repeat blood test done in the new year in the hope that my reading will have gone down again - it shot up again when I stopped taking simvastatin for a couple of weeks due to the pain. I am now trying the diet route, but not easy with Christmas looming!

[Sqad]

Wak.......honestly?.......not much difference.

Solid aspirin is less likely to cause gastric erosions than soluble aspirin.......so they say!

[theprof]

I agree that there's isn't much difference. From a historical perspective, the study by Muir and Cossar is certainly interesting in this respect:

http://www.ncbi.nlm.n.../brmedj03214-0017.pdf

as is this one:

http://www.ncbi.nlm.n.../brmedj02957-0055.pdf

I well remember the sub-lingual aspirin/glycine tablets referred to in the article.

The point is that the BNF makes no comment on the advantages of soluble aspirin over conventional aspirin, and this says it all to my mind. I think it's down to personal preference at the end of the day and what the individual patient believes in.

[BertiWooster]

Crikey , given that this thread is still going .

If you are still there prof /sqad .

Would taking aspirin / statin , say on alternative days . or say every two days , compromise / reduce significantly the effectiveness of the medication ?

[theprof]

As far as aspirin is concerned, yes it would BertiWooster. It needs to be taken daily according to recent medical opinion.. As far as statins are concerned, I'd suggest that you should be aiming to minimise the side effects such as myalgia, although your GP will direct you to take the dose daily.

Alternate day statin therapy will not enable your GP to conclude that you are not taking a daily dose of the statin concerned. I suggest you base the dosage upon the side effects encountered. However, remember that a low fat/cholesterol diet should allow you to maintain low cholesterol without statin therapy.

[BertiWooster]

Just to clarify prof ( at the risk of sounding dumb )

Are you saying that you dont have to take the statins on a daily basis for it to be effective - if so what would be the maximum period between doses before it loses it's effectiveness ?

[honky-tonk]

I came off statins and tried the low fat diet and it didnt work, Gp said my high cholesterol was hereditary. Back on the statins again same problem muscular pain, after 6 months i now take half of the tablet, will be interesting to find out what my next cholesterol test shows.

[theprof]

It's not a dumb question BertiWooster.Theoretically, yes you have to take the statin daily for maximum effectiveness. No matter which statin you're taking, the dosage has been calculated through trials for maximum effectiveness and each statin has a different dosage regime. In this respect, you need to realise that the drug company and your GP know best.

Each statin is different, which means that it's not possible to provide an opinion on the maximum period between doses before it loses it's effectiveness. The point I was making was that in the event of side effects such as myalgia becoming uncomfortable or unbearable, it might be worthwhile taking the medication on alternate days to see if these unpleasant side effects can be minimised. It's not ideal, but might be preferential to the patient discontinuing the therapy completely against the advice of his or her GP.

Overall remember that in patients where statin therapy is indicated , some treatment is better than none at all.

[welshlibranr]

I wouldn't do it without being advised to do so by my doctor!..............

[theprof]

honky-tonk, it sounds like you have familial hypercholesterolaemia. Untreated, no matter what you do, your cholesterol level will remain high. Once again, you need to balance the statin dosage against the side effects, but in your case, it is very important that you continue with statin therapy indefinitely.

[theprof]

Good advice welshlibranr.