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[Solitary lesions of the rectum caused by suppositories combining acetylsalicylic acid and paracetamol].

The reports of 8 female patients who, because of recurrent headache, were using analgesic suppositories containing acetylsalicylic acid and paracetamol (Perdolan) for more than two years are analyzed. Symptoms were nonspecific: anal pain, rectal tenesmus or bleeding. The lesions were located within 8 cm from the anal verge and consisted of superficial ulcerations, fibrotic scar tissue and rectal stenosis. Biopsies showed non-specific inflammation, limited to the rectum. Rectal prolapse or intussusception was not associated. By discontinuing the use of suppositories, symptoms usually resolved; rectal stenoses required anorectal dilatations and in 2 cases surgical resection. When solitary rectal lesions are observed in the absence of rectal prolapse, chemical aggression of the rectal mucosa by use of suppositories containing acetylsalicylic acid should be considered.

Acetaminophen↗

[Preparations of acetylsalicylic acid sustained-release tablets on hydrophilic matrix forms].

The aim of this study was to prepare a tablet with acetylsalicylic acid based on hydrophilic matrix form by means of polyvinyl alcohol. The liberation was carried out with the column dissolution-rate method. In contrast to other studies, the percentage of the cumulative liberation is decreased by increasing the drug concentration. Acetylsalicylic acid caused a decrease of the wetting and the rate of swelling.

Aspirin↗

Gastric irritation of oxaprozin, a new nonsteroidal, antiinflammatory drug, in comparison to acetylsalicylic acid and indomethacin: a gastric potential difference analysis.

For the evaluation of gastric irritation of oxaprozin in comparison to indomethacin and acetylsalicylic acid, a study was carried out with eight healthy male volunteers, investigating doses of 600 and 1200 mg of oxaprozin compared to therapeutical equivalents of 50 mg indomethacin and 1000 mg acetylsalicylic acid. Gastric irritation was checked with the model of the transmural gastric potential difference. The model is based on the assumption that a change in electric tension caused by a lesion of the gastric mucosa, which leads to an increasing permeability of the cell membrane for electrolytes, is a sensitive parameter for cell disintegrity. The results of the study show that oxaprozin has less irritative potency than indomethacin and can thus be qualified as an antiinflammatory drug with a minimum of gastric irritation.

Adult↗

[The combination of acetylsalicylic acid and dipyridamole is more effective in secondary prevention following transient ischaemic attack or cerebral infarction: the debate is closed].

The European/Australasian stroke prevention in reversible ischaemia trial (ESPRIT) confirms that long-term administration of the combination acetylsalicylic acid and dipyridamole is more effective than acetylsalicylic acid in reducing the risk of vascular events after cerebral ischaemia of arterial origin. The results of this study in combination with the results of previous studies have provided sufficient evidence for the use of this therapy in clinical practice.

Anticoagulants↗

Lowering of plasma isoxicam concentrations with acetylsalicylic acid.

The pharmacokinetics of isoxicam 200 mg administered orally in 10 healthy male volunteers was studied before and during administration of acetylsalicylic acid 3.9 g daily by mouth starting 5 days after isoxicam. There was a statistically significant decrease in plasma isoxicam concentrations, but no significant change in time to reach maximum plasma concentration or disappearance time. The mechanisms of this interaction is probably competitive displacement of isoxicam from albumin by acetylsalicylic acid or salicylate. These results are consistent with the known effect of ASA in producing competitive displacement of other protein bound antiinflammatory drugs.

Administration, Oral↗

[Dosage of acetylsalicylic acid in the prevention and therapy of intrauterine growth retardation].

The authors recommend, based on their own experience, an optimal dose of acetylsalicylic acid in treatment of IUGR. The therapeutic effect was not proved conclusively and views are controversial. Based on a retrospective group from the years 1993, 1994 and 1995 the authors assume that treatment of IUGR by acetylsalicylic acid is indicated and they recommend a dose of 100 mg per day (e.g. one tablet of Anopyrin).

Aspirin↗

Determination of acetylsalicylic acid and metabolites in biological fluids by high-performance liquid chromatography.

A new method has been developed for the determination of acetylsalicylic acid, salicylic acid, salicyluric acid and gentisic acid in plasma, urine and tissue homogenates by simple extraction with ethyl acetate, evaporation and redissolution and measuring by high-performance liquid chromatography. Linearity, reproducibility and recovery were determined. Experiments were carried out to investigate the decomposition of acetylsalicylic acid in plasma with fluoride at different temperatures. The method has been used for pharmacokinetic experiments and an example is given.

Animals↗

[Experimental study of the effect of acetylsalicylic acid on the ultrastructure and function of thrombocytes].

Data are presented on yak platelet ultrastructure (in comparison with human platelets), and on acetylsalicylic acid influence on the platelet ultrastructure and function. The following species features of this animals are associated with their adaptation to high-altitude hypoxia: organization of alpha-granules, mitochondria, the contractile system (microtubes, F-actin), ovoid form of platelets. Acetylsalicylic acid influences the yak platelet plasma membrane inducing fragmentation, which is attended by a rise in the total number of platelets, by the appearance of a great number of microforms, and by the reduction of functional activity. The above changes remained up to 11 days from the beginning of the drug action.

Altitude↗

The influence of Eudragit type on the dissolution rate of acetylsalicylic acid from matrix tablets.

The effect of four Eudragits used as matrix substances on the physical characteristics of tablets and on the dissolution rate of acetylsalicylic acid has been investigated. The concentration of matrix substance necessary for achieving the appropriate effect of sustained release of acetylsalicylic acid (ASA) depends on the type of Eudragit used. For tablets prepared using Eudragit RS-100, Eudragit L-100-55 and Eudragit S-100, the acceptable dissolution rate of ASA was obtained with only 3% of polymer. In the case of Eudragit RL-100, to obtain the same effect, 10% of polymer was required. The dissolution data were evaluated on the basis of theoretical dissolution equations and by linear transformation of dissolution curves. The following mathematical models were employed: zero order equation, first order kinetics, Hixon-Crowell's cube root kinetics and diffusion model. The results indicated that the fitness of the kinetic model was dependent on the type of Eudragit used.

Acrylic Resins↗

[The treatment of transitory ischemic attacks with acetylsalicylic acid: results of a double-blind-study (author's transl)].

In a randomised double-blind longterm study the value of acetylsalicylic acid in prophylaxis against relapse was investigated against placebo in 58 patients with transitory ischemic attacks of prolonged reversible insults. During the 24 months of observation, significantly fewer relapses of cerebral ischemia occurred in patients with carotid transient ischemia attacks under acetylsalicyclic acid than in the control group. The recurrences usually took the form of transitory ischemic attacks. Of the 5 cerebral infarcts, 4 occurred in the control group, 3 patients died. Patients with vertebrobasilar insufficiency showed no response. On account of the relatively small number of patients the result of the study is to be regarded rather as a confirmation of the results of a larger series of investigations in the USA and Canada than solely a proof of the efficacy of acetylsalicylic acid.

Aspirin↗

Effect of acetylsalicylic acid on experimentally induced arterial thrombosis in rats.

Acetylsalicylic acid (ASA) was tested for its antithrombotic activity in the arterial system after prophylactic administration to rats, using a new standardized method. Damage of the vessel wall was produced by chilling a small segment of the left carotid artery. Dose related, significant results were obtained after 3 mg/kg orally. If higher doses (10 and 30 mg/kg) are administered, the formation of non-occlusive thrombi is inhibited by 70--90% on the basis of thrombus weight. As the frequency distributions show, there are significantly more zero-values in the ASA treated groups (total 50%) than in the control groups. However, the incidence of occlusive thrombi was not changed by ASA. The long-lasting effect of ASA in inhibition of platelet aggregation was confirmed. The formation of arterial thrombi is significantly inhibited after prophylactic administration of 30 and 10 mg/kg up to 48 h before initiation of thrombosis. After administration of 3 mg/kg orally, only insignificant effects were observed. Thus the duration of action depends on the dose used.

Animals↗

Perinatal pharmacokinetics of acetylsalicylic acid.

Pregnant women were treated with infusions of acetylsalicylic acid (ASA). The plasma concentrations of total salicylate or those of ASA and salicylic acid (SA) were determined. The ASA steady state was reached after 2 h of infusion whereas 3 days seemed necessary to reach the steady state of SA. In a further study during the late phase of cervical dilatation (12 min - 2 h before birth) healthy pregnant women were given 1 g ASA as a single i.v. bolus injection. The resulting plasma levels of ASA and SA in the mothers during delivery, the plasma concentrations in umbilical cord blood and in blood obtained from the newborn several hours after birth were measured. With increasing time the SA concentrations in the umbilical cord blood plasma approached those of the mothers. On the other hand, the umbilical cord blood concentrations of ASA did not approach the maternal concentrations, probably because of the ASA esterase activity at the placental barrier. The plasma concentrations in the newborn indicated that the newborn is able to degrade ASA and to excrete SA. However, the velocities are lower than the respective velocities in adults.

Aspirin↗

Reduced sensitivity of platelets from type 2 diabetic patients to acetylsalicylic acid (aspirin)-its relation to metabolic control.

Aspirin (acetylsalicylic acid, ASA), which is recommended for primary and secondary prevention in diabetes mellitus (DM), has been shown to have a lower antiplatelet activity in diabetic patients. We conducted a crossover designed observational study to evaluate whether there is an association between the parameters relevant to metabolic control of diabetes and platelet sensitivity to aspirin in type 2 diabetic patients. Platelets' ability to adhere and aggregate was monitored with the use of platelet function analyser (PFA-100 collagen/epinephrine closure time, CT(CEPI) or collagen/ADP closure time, CT(CADP)), classical turbidimetric aggregometry and whole blood electrical aggregometry (WBEA), using collagen (WBEA(coll)), ADP (WBEA(ADP)) and arachidonic acid (WBEA(AA)) as platelet agonists, in 48 control healthy volunteers (mean age+/-S.D., 49+/-9 years) and 31 type 2 DM patients (50+/-9 years; HbA(1c) 9.4+/-1.6%). In majority of control subjects (69%) and minority of diabetic patients (29%, p=0.0006), the use of 150 mg aspirin daily for 1 week significantly reduced platelet adhesiveness and reactivity (by 14.1% in diabetes vs. 78.6% in control, p(np)=0.0035, as expressed by the relative changes in CT(CEPI)). Aspirin reduced WBEA(coll) and WBEA(AA) to a lesser extent in diabetic patients (by 2.1% vs. 8.3% in controls, p(np)=0.0397, and by 97.3+/-12.8% vs. 100% in controls, p(np)=0.0383, respectively), which corresponded to ASA-mediated decreased aggregation in platelet-rich plasma (PRP, r(S)=0.45 and r(S)=0.78 for collagen- or arachidonate-agonized platelets, p<0.01 or lower). The maximal inhibition of platelet aggregation was lower and IC(50) higher in diabetic compared to control subjects, both in the presence of arachidonic acid (71% vs. 39%, p(np)0.0001; 0.5 microg/ml vs. 1.3 microg/ml, p<0.0001) and collagen (52% vs. 35%, p<0.0004; 1.6 microg/ml vs. 2.1 microg/ml, p<0.01). The reduced response of platelets from diabetic subjects to aspirin was associated with a higher level of HbA(1c), lower concentration of HDL-cholesterol and a higher total cholesterol concentration. Overall, there is evidence that reduced platelets response to aspirin may occur more often in diabetic patients. Poor metabolic control may play a role in the reduced platelet sensitivity to aspirin in DM patients. Thus, our findings strongly support the requirements for an excellent near-normal metabolic control and may suggest a need for alternative ASA dosing schedules in DM patients.

Adult↗

Pharmacokinetic interaction of acetylsalicylic acid and dipyridamole.

It is often recommended that acetylsalicylic acid (ASA) and dipyridamole should be given together in order to obtain secondary prophylaxis against certain ischaemic diseases. Therefore, the possible pharmacokinetic interactions between these agents were assessed following single-dose exposures in 14 healthy volunteers. The plasma concentrations of ASA, salicylic acid (SA) and dipyridamole were measured by selective h.p.l.c. techniques. It was found that, while dipyridamole kinetics were unaffected by concurrent ASA, concurrent dipyridamole significantly enhanced the peak concentration (24%) and AUC (27%) of ASA. Thus, co-administered dipyridamole might influence the anti-platelet effect of ASA.

Adult↗

Relative bioavailability and bioequivalence of a newly developed fixed combination sachet of acetylsalicylic acid and pseudoephedrine compared with a preliminary combination.

Acetylsalicylic acid (ASA) and pseudoephedrine (PSE) are often administered together for the treatment of symptoms of the common cold, i.e., nasal congestion, runny nose, sore throat and headache. Based on this fact we developed a fixed combination of 500 mg ASA and 30 mg PSE, the recommended doses for both drugs for treating symptoms of the common cold, as granulate to be dissolved in water for administration. The purpose of this open, randomized, three-factorial (three-treatment, three-period, six-sequence) Latin Square clinical study was to investigate the relative bioavailability of ASA and PSE as well as the establishment of bioequivalence after single administration of the fixed combination (final formulation for approval) of 500 mg ASA/30 mg PSE*HCl and the preliminary formulation of this combination. Pharmacokinetic characteristics AUC(norm) and C(max,norm) of ASA, its metabolite SA, and PSE, were determined as measure of rate and extent of absorption of the two formulations. The treatment ratios final/preliminary formulation and their corresponding 90% confidence intervals were calculated to establish bioequivalence. Additionally, descriptive statistics were calculated for the parameters t(max), t((1/2)), and mean residence time (MRT). In total, data from 18 healthy male volunteers were included in the pharmacokinetic evaluation. The primary target parameters were analyzed using an analysis of variance (ANOVA) after logarithmic transformation of the data. Confidence intervals of 90% were calculated for the geometric means of ratios using the mean square error term of the ANOVA. Bioequivalence criteria were fulfilled for AUC(norm) and C(max,norm). Geometric means of individual ratios of AUC(norm) and of C(max,norm) showed equal bioavailability of the new formulation compared with the preliminary. Furthermore, a relative bioavailability of approximately 100% of the preliminary formulation was shown for the newly developed formulation for all parameters. The parameters t(max), t((1/2)), and MRT showed comparable results for ASA, SA, and PSE, respectively, in both formulations. The supplementary evaluation for the non-normalized original parameters AUC and C(max) also revealed bioequivalence. For the newly developed formulation, the arithmetic means of the parameters AUC and C(max) for PSE were 1040.66 mg/h*l and 134.52 mg/l, for SA 142.28 mg/h*l and 30.34 mg/l, respectively. The median t(max) values were 0.67 h for PSE and 0.92 h for SA. Both treatments were safe and well tolerated.

Administration, Oral↗

Asthma improved by acetylsalicylic acid and other nonsteroidal anti-inflammatory agents.

Acetylsalicylic acid (ASA) and other nonsteroidal anti-inflammatory drugs (NSAID) cause a variety of symptoms in patients sensitive to these drugs. These include wheezing, rhinorrhea, flushing, pruritus, urticaria, hypotension and loss of consciousness. Conversely, improvement of asthma with the use of these drugs in patients who do not have idiosyncratic reactions to ASA (ASA-nonsensitive) has also been observed both with respect to clinical symptoms and pulmonary function tests.

Anti-Inflammatory Agents, Non-Steroidal↗

Inhibition of furosemide-induced natriuresis by acetylsalicylic acid in dogs.

The effect of intravenously administered acetylsalicylic acid (ASA) has been investigated in two sets of experiments in conscious dogs. In the first part of the study ASA 70-90 mg/kg was infused for 40 min. Urine flow, free water clearance, renal blood flow and urinary excretion of sodium did not change significantly as compared to placebo treated animals. This is in contrast to the effects of comparable ASA doses in the pentobarbital anaesthetized dog. In the second part of the study the effects of pre-treatment with the same ASA doses of 5 ml 0.6% NaCl (placebo) on some renal effects of furosemide 1 mg/kg (intravenously) were investigated. In the placebo group acute furosemide treatment increased CIN in five out of six dogs and CPAH in all six dogs, these increases being most prominent the first 10 min after drug administration. After pre-treatment with ASA the initial increases in CIN and CPAH were almost abolished. CIN was reduced by 23.8% and CPAH by 30.6% during the first six clearance periods (0-6- min) after diuretic treatment in the ASA group as compared to the placebo group. Although urinary sodium excretion also increased in ASA pre-treated dogs, the effect of furosemide was greater in all dogs in the placebo group (P less than 0.05), and the effect of furosemide on fractional tubular reabsorption of sodium was significantly attenuated after pre-treatment with ASA.

Animals↗

[The rate of acetylsalicylic acid non-respondents among patients hospitalized for acute coronary disease, previously undergoing secondary salicylic acid prophylaxis].

The authors determined the rate of acetylsalicylic acid (ASA) non-responders among patients receiving secondary prevention due to cardiovascular diseases at the appearance of acute coronary events. The non-responders were defined as: patients who have been treated with ASA because of acute coronary syndrome, but the subsequently performed platelet aggregation study did not confirmed an appropriate platelet inhibition. Among the 75 patients being investigated (44 male, 31 female, average age: 61.3 ys) 21 were hospitalized due to acute myocardial infarction and 54 for unstable angina, respectively. The daily doses of ASA were 200-325 mg. The aggregation of platelets was measured within 24 h after the admission. The investigations were performed with different amounts of 4 different inducers (ADP, arachidonic acid, epinephrine and collagen) taking dose-response curves. The antiaggregatory treatment with ASA was considered to be ineffective if the typical aggregation curves were obtained above the following final concentrations of the inducers: ADP: > 5 microM, epinephrine: > 5 microM, arachidonic acid: > 250 microM, collagen: > 2 micrograms/ml. These upper-threshold concentrations of the inducers were determined with the help of the data of healthy drug free volunteers. Twenty-six of the 75 patients (34%) were found to be non-responder to ASA, whereas the antiaggregatory effect of ASA was proven in 49 cases. No differences were found in gender. The compliance was proven with the HPLC-determination of urinary metabolites of ASA performed immediately after the upon admission. Seven patients (10.9%) showed a non-compliance, not showing any traces of ASA-metabolites in their urine. The authors emphasizing the importance of the laboratory control even of the prophylactic ASA treatment in order to continue the effective antiaggregatory therapy with other effective drugs.

Acute Disease↗