The name may be a tongue twister, but the active ingredient has star quality: acetylsalicylic acid (ASA). Whether it’s a headache, toothache, fever or a hangover after a night of drinking – almost everyone has been helped by ASA at one time or another. This little brother of salicylic acid was first produced around 1850 by the French chemist Charles Frederick Gerhardt. However, it was left to the German chemists Felix Hoffmann and Heinrich Dreser to help the analgesic substance achieve a decisive breakthrough.
ASA became aspirin
The substance’s soothing effects had been recognized early on, but its side effects were devastating. Due to impurities, ingestion led to burns of the mouth and mucous membranes of the stomach – a problem that the young Bayer chemists Hoffmann and Dreser eliminated and henceforth presented the substance in powder form. Two years later, in 1899, the preparation Aspirin
of the Bayer company was born, which today has become synonymous with painkillers in general. Painkillers: which one, when and for what?
ASA: one active ingredient – many effects
The active ingredient acetylsalicylic acid, or ASA for short, is now widely used. Beyond its analgesic effect, researchers have found that the active ingredient can be used to prevent circulatory problems in the vascular system of the heart and brain. Acetylsalicylic acid reduces the occurrence of thrombosis in the vessels, i.e. it counteracts the clumping together of blood platelets. For this reason, the drug is used, among other things, before long air travel to prevent travel thrombosis. A further area of application for ASA is anti-inflammation. The active ingredient can therefore be used for rheumatism and arthritis. However, it must be taken in much higher doses and can therefore lead to increased side effects such as bleeding in the gastrointestinal tract. Finally, its 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 United States for emergency use in acute myocardial infarction. In 1988, an American study involving 22,000 people made headlines: Daily aspirin use in healthy people was said to reduce the risk of heart attack by 44 percent, according to a study by the American Heart Association. This was the entry point for aspirin as a “preventive drug,” the use of which, however, has to be tailored to the individual. That’s because the preventive use of ASA is highly controversial. Administering a drug to healthy people every day over a period of several years – even if only in small doses – can have negative consequences in view of the side effects. The risk of being harmed by the side effects should not be disregarded with such long-term use. ASA has also been shown to have a preventive effect against various types of cancer of the digestive tract, such as colon cancer or esophageal cancer. However, even in this context, precautionary use over several years is controversial because of the risk of developing internal bleeding.
Dosage of acetylsalicylic acid.
The maximum amount per day should not exceed three grams – the equivalent of six 500 milligram tablets. A single dose of ten grams is life-threatening because the blood then becomes too acidic. This leads to acceleration of respiration and stimulation of kidney activity, which can result in dangerous fluid loss. This can lead to tissue destruction and ultimately death. The commercially available dosages in the form of tablets contain 500 milligrams of active ingredient, while the dosage for effervescent tablets is somewhat lower at 400 milligrams. Chewable tablets, which have only recently appeared on the market, are taken without water and can therefore be conveniently taken along.
Acetylsalicylic acid in combination with caffeine and vitamin C.
In addition, ASA preparations are offered in combination with other active ingredients, such as caffeine, since it became known that caffeine enhances the effect of ASA. The active ingredient also has a positive effect on the body’s immune system when used as a combination preparation with vitamin C. 4 facts about ASA – iStock.com/Andrei_Andreev
Risks and side effects of ASA
Acetylsalicylic acid also has its disadvantages. Sensitive people react to it with irritation, heartburn, and rarely bleeding from the stomach and intestinal mucosa.If higher doses of ASA are taken, the risk of more severe bleeding increases considerably. In rare cases, iron deficiency anemia can then even occur because the iron bound in the red blood pigment is lost through the bleeding in the stomach. This aspect is particularly important because acetylsalicylic acid as an active ingredient does not require a prescription, so aspirin
and the corresponding preparations from other manufacturers are readily available over the counter. It is therefore difficult to control for any incorrect dosing. Anyone who takes ASA regularly without instructions from their physician should keep an intake diary and discuss this with their physician or pharmacist.
Consequences of long-term intake of ASA
Long-term use of ASA may also lead to the following side effects:
- Dizziness
- Nausea
- Impaired hearing
- Visual disturbances
- Ringing in the ears
However, these side effects disappear when the dose is reduced or the drug is stopped altogether.
Allergy to ASA
Allergic reactions in the form of skin rashes or respiratory spasms have also been observed. So-called “aspirin asthma” particularly affects predisposed patients who react to the active ingredient with asthma-like respiratory spasms.
ASA: 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 life-threatening Reye’s syndrome, in which the brain and liver can be severely damaged. The disease itself is not treatable, and therapy is limited to treating the symptoms: Liver function is supported and attempts are made to lower the increased intracranial pressure with medication. The exact triggers for this severe, non-contagious disease are not yet known. Researchers suspect, among other things, a genetic predisposition. For children and adolescents, however, there are a number of well-tolerated drugs, such as acetaminophen, that can be used for pain and to reduce fever.
Avoid ASA during pregnancy
Acetylsalicylic acid should be taken during the first five months of pregnancy only after close consultation with a doctor. From the beginning of the sixth month of pregnancy, ASA should not be used, as it can cause serious harm to the mother or baby. Paracetamol is also an alternative painkiller. It is also recommended to avoid ASA during breastfeeding as a precaution, since the active ingredient can pass into breast milk.
Other contraindications of ASA
In addition, the active substance must not be administered to:
- Hypersensitivity to acetylsalicylic acid or other salicylates.
- Acute stomach or intestinal ulcers
- Increased bleeding tendency
- Liver and kidney failure
- Cardiomyopathy
- Taking methotrexate
New avenues for acetylsalicylic acid.
How versatile the active ingredient can be used has already been demonstrated in recent years. In 2004, the European Commission granted Bayer HealthCare AG orphan drug status for acetylsalicylic acid for the treatment of polycythemia vera. In this very rare disease, blood cells multiply uncontrollably. Patients therefore suffer in particular from circulatory disorders and vascular occlusion, even premature heart attack or stroke. The ability of acetylsalicylic acid to inhibit the clumping of blood platelets significantly reduces the risk of heart attack or stroke. In the manufacturer’s view, the Commission’s decision confirms that the additional treatment with aspirin
-active ingredient acetylsalicylic acid (ASA) can significantly reduce patients’ risk of suffering a heart attack or stroke. Orphan drug status can be granted for diseases that are so rare that extensive clinical trials, as required in medicine, are often not possible. In order to give greater medical attention to these – as in the case of polycythemia vera, for example – often life-threatening diseases (orphan), orphan drug status assures the manufacturers of suitable drugs far-reaching support and facilitates approval. 10 tips to combat headaches
