Aspirin (Acetylsalicylic Acid)

Aspirin (Acetylsalicylic Acid) is a antiplatelet / nsaid medicine available in Bangladesh under many brand names. Below are its uses, side effects and precautions — and every brand with its current price.

• Prevention of heart attack and stroke in patients with known heart disease, prior heart attack/stroke, stents or bypass surgery (secondary prevention)
• High-risk patients — only when the doctor judges benefit exceeds bleeding risk
• During a suspected heart attack — as advised by emergency medical services
• Higher doses treat pain, fever and inflammation, but paracetamol is preferred for routine fever in Bangladesh (see dengue warning)

Possible side effects include:

• Stomach irritation, heartburn, nausea
• Bleeding tendency — easy bruising, bleeding gums, nosebleeds, longer bleeding from cuts
• Stomach or duodenal ulcers; black tarry stools or vomiting blood are emergencies
• Allergic reactions — rash, wheezing (aspirin-sensitive asthma)
• Ringing in the ears (tinnitus) at high doses
• Rare in children with viral fever: Reye's syndrome — a life-threatening swelling of the brain and liver

• DENGUE WARNING: Never take aspirin during dengue fever or suspected dengue — it sharply increases the risk of dangerous bleeding. In any acute fever in Bangladesh, use paracetamol and get dengue tested first.
• CHILDREN: Do not give aspirin to children or teenagers with fever, flu or chickenpox — risk of Reye's syndrome, a rare but often fatal condition. Use paracetamol instead.
• Tell every doctor and dentist you take aspirin before any surgery, tooth extraction or procedure — but do not stop it yourself.
• Tell your doctor about past ulcers, bleeding disorders, asthma, gout, kidney or liver disease.
• Avoid regular alcohol — it multiplies stomach-bleeding risk.
• Watch for black stools, blood in vomit or urine, unusual bruising — report immediately.

• Other blood thinners (warfarin, clopidogrel, rivaroxaban, heparin): major bleeding risk — combine only under strict medical supervision
• NSAID painkillers (ibuprofen, diclofenac, naproxen): add stomach-bleeding risk and ibuprofen can block aspirin's heart protection — ask your doctor before using painkillers
• Corticosteroids: increased ulcer and bleeding risk
• SSRIs (fluoxetine, escitalopram): higher bleeding tendency
• Methotrexate: aspirin raises its toxicity
• Diabetes medicines: high-dose aspirin can lower sugar further
• Antihypertensives and diuretics: effect may be reduced

• Allergy to aspirin or other NSAIDs, or aspirin-induced asthma
• Active stomach or duodenal ulcer, or active bleeding anywhere
• Bleeding disorders (haemophilia), severe platelet deficiency
• Dengue fever or suspected dengue
• Children and teenagers with viral fever, flu or chickenpox (Reye's syndrome)
• Severe liver or kidney failure
• Third trimester of pregnancy (analgesic doses)

Pregnancy: Regular analgesic-dose aspirin should be avoided, especially in the third trimester, as it can cause bleeding in mother and baby and premature closure of a vessel in the baby's heart. However, doctors sometimes deliberately prescribe low-dose aspirin in pregnancy to prevent pre-eclampsia — take it only exactly as your obstetrician directs.

Lactation: Occasional low doses are unlikely to harm, but regular use is generally avoided because of a theoretical Reye's syndrome risk in the infant. Consult your doctor; paracetamol is preferred for pain or fever while breastfeeding.

Store below 30°C in a dry place away from light and moisture — aspirin degrades in humid conditions (a vinegar smell means the tablets have spoiled). Keep in the original pack, tightly closed, and out of the reach of children. Do not use after the expiry date.