acid acetylsalicylic

Summary

Aspirin is a salicylate used đồ sộ treat pain, fever, inflammation, migraines, and reducing the risk of major adverse cardiovascular events.

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Brand Names

Aggrenox, Alka-seltzer, Alka-seltzer Fruit Chews, Anacin, Arthriten Inflammatory Pain, Ascomp, Aspi-cor, Aspir-low, Bayer Aspirin, Bayer Womens, Bc Arthritis, Bc Original Formula, Bufferin, Duoplavin, Durlaza, Ecotrin, Ecpirin, Endodan Reformulated May 2009, Equagesic, Exaprin, Excedrin, Excedrin PM Triple kích hoạt, Fasprin, Fiorinal, Goody's Body Pain, Goody's Extra Strength, Goody's PM, Miniprin, Norgesic, Norgesic Forte, Orphengesic, Pamprin Max Formula, Robaxisal, ST. Joseph Aspirin, Stanback Headache Powder Reformulated Jan 2011, Trianal, Trianal C, Vanquish, Vazalore, Yosprala

Generic Name
Acetylsalicylic acid
Commonly known or available as Aspirin
DrugBank Accession Number
DB00945
Background

Also known as Aspirin, acetylsalicylic acid (ASA) is a commonly used drug for the treatment of pain and fever due đồ sộ various causes. Acetylsalicylic acid has both anti-inflammatory and antipyretic effects. This drug also inhibits platelet aggregation and is used in the prevention of blood clots stroke, and myocardial infarction (MI) Label.

Interestingly, the results of various studies have demonstrated that long-term use of acetylsalicylic acid may decrease the risk of various cancers, including colorectal, esophageal, breast, lung, prostate, liver and skin cancer 15. Aspirin is classified as a non-selective cyclooxygenase (COX) inhibitor 11,14 and is available in many doses and forms, including chewable tablets, suppositories, extended release formulations, and others 19.

Acetylsalicylic acid is a very common cause of accidental poisoning in young children. It should be kept out of reach from young children, toddlers, and infants Label.

Type
Small Molecule
Groups
Approved, Vet approved
Structure

Weight
Average: 180.1574
Monoisotopic: 180.042258744
Chemical Formula
C9H8O4
Synonyms
  • 2-Acetoxybenzenecarboxylic acid
  • 2-Acetoxybenzoic acid
  • Acetylsalicylate
  • Acetylsalicylsäure
  • acide 2-(acétyloxy)benzoïque
  • Acide acétylsalicylique
  • ácido acetilsalicílico
  • Acidum acetylsalicylicum
  • ASA
  • Aspirin
  • Aspirina
  • Azetylsalizylsäure
  • o-acetoxybenzoic acid
  • O-acetylsalicylic acid
  • o-carboxyphenyl acetate
  • Polopiryna
  • Salicylic acid acetate
External IDs
  • BAY1019036
  • NSC-27223
  • NSC-406186
Indication

Pain, fever, and inflammation

Acetylsalicylic acid (ASA), in the regular tablet sườn (immediate-release), is indicated đồ sộ relieve pain, fever, and inflammation associated with many conditions, including the flu, the common cold, neck and back pain, dysmenorrhea, headache, tooth pain, sprains, fractures, myositis, neuralgia, synovitis, arthritis, bursitis, burns, and various injuries. It is also used for symptomatic pain relief after surgical and dental procedures Label.

The extra strength formulation of acetylsalicylic acid is also indicated for the management migraine pain with photophobia (sensitivity đồ sộ light) and phonophobia (sensitivity đồ sộ sound)Label.

Other indications

ASA is also indicated for various other purposes, due đồ sộ its ability đồ sộ inhibit platelet aggregation. These include:

Reducing the risk of cardiovascular death in suspected cases of myocardial infarction (MI) Label.

Reducing the risk of a first non-fatal myocardial infarction in patients, and for reducing the risk of morbidity and mortality in cases of unstable angina and in those who have had a prior myocardial infarction Label.

For reducing the risk of transient ischemic attacks (TIA) and đồ sộ prevent atherothrombotic cerebral infarction (in conjunction with other treatments) Label.

For the prevention of thromboembolism after hip replacement surgery Label.

For decreasing platelet đồ sộ platelet adhesion following carotid endarterectomy, aiding in the prevention of transient ischemic attacks (TIA) Label.

Used for patients undergoing hemodialysis with a silicone rubber arteriovenous cannula inserted đồ sộ prevent thrombosis at the insertion site Label.

Important note regarding use of the extended-release formulation 21

In the setting of acute myocardial infarction, or before percutaneous interventions, the extended-release sườn of acetylsalicylic acid should not be used. Use immediate-release formulations in scenarios requiring rapid onset of action Label,21. The extended-release sườn is taken đồ sộ decrease the incidence of mortality and myocardial infarction (MI) for individuals diagnosed with chronic coronary artery disease (CAD), including patients with previous myocardial infarction (MI) or unstable angina or with chronic stable angina. Additionally, the extended-release sườn is used đồ sộ decrease the risk of death and recurrent episodes of stroke in patients with a history of stroke or TIA 21.

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Associated Conditions
  • Acute Coronary Syndrome (ACS)
  • Anxiety
  • Atherothrombotic cerebral infarction
  • Cardiovascular Disease (CVD)
  • Cardiovascular Events
  • Cardiovascular Mortality
  • Colorectal Adenomas
  • Colorectal Cancer
  • Common Cold
  • Coronary artery reocclusion
  • Death
  • Dyspeptic signs and symptoms
  • Fever
  • Flu caused by Influenza
  • Headache
  • Heterozygous Familial Hypercholesterolemia (HeFH)
  • Inflammation
  • Juvenile Idiopathic Arthritis (JIA)
  • Major Adverse Cardiovascular and Cerebrovascular Events (MACCE)
  • Menstrual Pain
  • Migraine
  • Morbidity
  • Mucocutaneous Lymph Node Syndrome
  • Muscle Contraction
  • Myalgia
  • Myocardial Infarction
  • Myocardial Infarction (MI), first occurrence
  • Neuropathic Pain
  • Pain
  • Pain caused by Common Cold
  • Pain caused by Rheumatism
  • Pericarditis
  • Polycythemia Vera (PV)
  • Rheumatism
  • Rheumatoid Arthritis
  • Rhino Sinusitis
  • Severe Pain
  • Spondyloarthropathies
  • Stroke
  • Systemic Lupus Erythematosus
  • Tension Headache
  • Thromboembolism
  • Thrombosis
  • Toothache
  • Transient Ischemic Attack
  • Vascular Death
  • Venous Thromboembolism
  • Acute Inflammation
  • Articular inflammation
  • Atherothrombotic events
  • Death caused by Myocardial Infarction
  • Fever or influenza-like illness
  • Moderate Pain
  • Prophylaxis of preeclampsia
  • Recurrent Ischemic Stroke
Associated Therapies
  • Anti-platelet Therapy
  • Hemodialysis Treatment
  • Secondary Prevention
Contraindications & Blackbox Warnings

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Pharmacodynamics

Effects on pain and fever

Acetylsalicylic acid disrupts the production of prostaglandins throughout the toàn thân by targeting cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) 9,10,11. Prostaglandins are potent, irritating substances that have been shown đồ sộ cause headaches and pain upon injection into humans. Prostaglandins increase the sensitivity of pain receptors and substances such as histamine and bradykinin. Through the disruption of the production and prevention of release of prostaglandins in inflammation, this drug may stop their action at pain receptors, preventing symptoms of pain. Acetylsalicylic acid is considered an antipyretic agent because of its ability đồ sộ interfere with the production of brain prostaglandin E1. Prostaglandin E1 is known đồ sộ be an extremely powerful fever-inducing agent Label.

Effects on platelet aggregation

The inhibition of platelet aggregation by ASA occurs because of its interference with thromboxane A2 in platelets, caused by COX-1 inhibition. Thromboxane A2 is an important lipid responsible for platelet aggregation, which can lead đồ sộ clot formation and future risk of heart attack or stroke Label.

A note on cancer prevention

ASA has been studied in recent years đồ sộ determine its effect on the prevention of various malignancies 15. In general, acetylsalicylic acid is involved in the interference of various cancer signaling pathways, sometimes inducing or upregulating tumor suppressor genes 15,17. Results of various studies suggest that there are beneficial effects of long-term ASA use in the prevention of several types of cancer, including stomach, colorectal, pancreatic, and liver cancers 16. Research is ongoing.

Mechanism of action

Acetylsalicylic acid (ASA) blocks prostaglandin synthesis. It is non-selective for COX-1 and COX-2 enzymes 9,10,11. Inhibition of COX-1 results in the inhibition of platelet aggregation for about 7-10 days (average platelet lifespan). The acetyl group of acetylsalicylic acid binds with a serine residue of the cyclooxygenase-1 (COX-1) enzyme, leading đồ sộ irreversible inhibition. This prevents the production of pain-causing prostaglandins. This process also stops the conversion of arachidonic acid đồ sộ thromboxane A2 (TXA2), which is a potent inducer of platelet aggregation Label. Platelet aggregation can result in clots and harmful venous and arterial thromboembolism, leading đồ sộ conditions such as pulmonary embolism and stroke.

It is important đồ sộ note that there is 60% homology between the protein structures of COX-1 and COX-2. ASA binds đồ sộ serine 516 residue on the active site of COX-2 in the same fashion as its binding đồ sộ the serine 530 residue located on the active site of COX-1. The active site of COX-2 is, however, slightly larger than thở the active site of COX-1, sánh that arachidonic acid (which later becomes prostaglandins) manages đồ sộ bypass the aspirin molecule inactivating COX-2 11,12. ASA, therefore, exerts more action on the COX-1 receptor rather than thở on the COX-2 receptor 14. A higher dose of acetylsalicylic acid is required for COX-2 inhibition 15.

TargetActionsOrganism
AProstaglandin G/H synthase 1

inhibitor

Humans
AProstaglandin G/H synthase 2

inhibitor

Humans
UAldo-keto reductase family 1 thành viên C1

inhibitor

Humans
U5'-AMP-activated protein kinase

activator

Humans
UEndothelin-1 receptor

inhibitor

Humans
UCellular tumor antigen p53

inducer

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Humans
U78 kDa glucose-regulated protein

inhibitor

binder

Humans
URibosomal protein S6 kinase alpha-3

inhibitor

Humans
UNF-kappa-B inhibitor alpha

inhibitor

Humans
UTumor necrosis factor-inducible ren 6 protein

inhibitor

downregulator

Humans
UCaspase-1

inhibitor

downregulator

Humans
UCaspase-3

inhibitor

downregulator

Humans
UInhibitor of nuclear factor kappa-B kinase subunit betaNot AvailableHumans
UExtracellular signal-regulated kinase (ERK)Not AvailableHumans
UG1/S-specific cyclin-D1

downregulator

Humans
UMyc proto-oncogene protein

downregulator

Humans
UProliferating cell nuclear antigen

downregulator

Humans
UCyclin A

downregulator

USialidase-1

inhibitor

Humans
Absorption

Absorption is generally rapid and complete following oral administration but absorption may be variable depending on the route, dosage sườn, and other factors including but not limited đồ sộ the rate of tablet dissolution, gastric contents, gastric emptying time, and gastric pH Label.

Detailed absorption information

When ingested orally, acetylsalicylic acid is rapidly absorbed in both the stomach and proximal small intestine. The non-ionized acetylsalicylic acid passes through the stomach lining by passive diffusion. Ideal absorption of salicylate in the stomach occurs in the pH range of 2.15 - 4.10. Intestinal absorption of acetylsalicylic acid occurs at a much faster rate. At least half of the ingested dose is hydrolyzed đồ sộ salicylic acid in the first-hour post-ingestion by esterases found in the gastrointestinal tract. Peak plasma salicylate concentrations occur between 1-2 hours post-administration Label.

Volume of distribution

This drug is distributed đồ sộ toàn thân tissues shortly after administration. It is known đồ sộ cross the placenta. The plasma contains high levels of salicylate, as well as tissues such as spinal, peritoneal and synovial fluids, saliva and milk. The kidney, liver, heart, and lungs are also found đồ sộ be rich in salicylate concentration after dosing. Low concentrations of salicylate are usually low, and minimal concentrations are found in feces, bile, and sweat Label.

Protein binding

50% đồ sộ 90% of a normal therapeutic concentration salicylate (a main metabolite of acetylsalicylic acid Label) binds plasma proteins, particularly albumin, while acetylsalicylic acid itself binds negligibly Label. Acetylsalicylic acid has the ability đồ sộ bind đồ sộ and acetylate many proteins, hormones, DNA, platelets, and hemoglobin Label.

Metabolism

Acetylsalicylic acid is hydrolyzed in the plasma đồ sộ salicylic acid. Plasma concentrations of aspirin following after administration of the extended-release sườn are mostly undetectable 4-8 hours after ingestion of a single dose. Salicylic acid was measured at 24 hours following a single dose of extended-release acetylsalicylic acid 21.

Salicylate is mainly metabolized in the liver, although other tissues may also be involved in this process Label. The major metabolites of acetylsalicylic acid are salicylic acid, salicyluric acid, the ether or phenolic glucuronide and the ester or acyl glucuronide. A small portion is converted đồ sộ gentisic acid and other hydroxybenzoic acids Label.

Hover over products below đồ sộ view reaction partners

Route of elimination

Excretion of salicylates occurs mainly through the kidney, by the processes of glomerular filtration and tubular excretion, in the sườn of không tính tiền salicylic acid, salicyluric acid, and, additionally, phenolic and acyl glucuronides Label.

Salicylate can be found in the urine soon after administration, however, the entire dose takes about 48 hours đồ sộ be completely eliminated. The rate of salicylate is often variable, ranging from 10% đồ sộ 85% in the urine, and heavily depends on urinary pH. Acidic urine generally sida in reabsorption of salicylate by the renal tubules, while alkaline urine increases excretion Label.

After the administration of a typical 325mg dose, the elimination of ASA is found đồ sộ follow first order kinetics in a linear fashion. At high concentrations, the elimination half-life increases Label.

Half-life

The half-life of ASA in the circulation ranges from 13 - 19 minutes. Blood concentrations drop rapidly after complete absorption. The half-life of the salicylate ranges between 3.5 and 4.5 hours Label.

Clearance

The clearance rate of acetylsalicylic acid is extremely variable, depending on several factors 6. Dosage adjustments may be required in patients with renal impairment Label. The extended-release tablet should not be administered đồ sộ patients with eGFR of less than thở 10 mL/min 21.

Adverse Effects

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Toxicity

Lethal doses

Acute oral LD50 values have been reported as over 1.0 g/kg in humans, cats, and dogs, 0.92 g/kg - 1.48 g/kg in albino rats, 1.19 g/kg in guinea pigs, 1.1 g/kg in mice, and 1.8 g/kg in rabbit models Label.

Acute toxicity

Salicylate toxicity is a problem that may develop with both acute and chronic salicylate exposure 7. Multiple organ systems may be affected by salicylate toxicity, including the central nervous system, the pulmonary system, and the gastrointestinal system. Severe bleeding may occur. In the majority of cases, patients suffering from salicylate toxicity are volume-depleted at the time of presentation for medical attention. Fluid resuscitation should occur immediately and volume status should be monitored closely. Disruptions in acid-base balance are frequent in ASA toxicity 7.

The acute toxicity of acetylsalicylic in animals has been widely studied. The signs of poisoning in rats from lethal doses are mild đồ sộ severe gastroenteritis, hepatitis, nephritis, pulmonary edema, encephalopathy, shock and some toxic effects on other organs and tissues. Mortality has been observed following convulsions or cardiovascular shock. An important differentiating property between various animal species is the ability đồ sộ vomit toxic doses. Humans, cats and dogs have this ability, but rodents or rabbits bởi not Label.

Chronic toxicity and carcinogenesis

Chronic ASA toxicity is frequently accompanied by atypical clinical presentations that may be similar đồ sộ diabetic ketoacidosis, delirium, cerebrovascular accident (CVA), myocardial infarction (MI) or cardiac failure. Plasma salicylate concentrations should be measured if salicylate intoxication is suspected, even if there no documentation available đồ sộ suggest ASA was ingested. In older age, nephrotoxicity from salicylates increases, and the risk of upper gastrointestinal hemorrhage is increased, with higher rates of mortality 8. It is also important đồ sộ note that ASA toxicity may occur even with close đồ sộ normal serum concentrations. Prevention of chronic ASA includes the administration of smallest possible doses, avoidance of concurrent use of salicylate drugs, and therapeutic drug monitoring. Renal function should be regularly monitored and screening for gastrointestinal bleeding should be done at regular intervals 8.

Chronic toxicity studies were performed in rodents. ASA was administered at doses measured đồ sộ be 2 đồ sộ đôi mươi times the maximum tolerated clinical dose đồ sộ mice for up đồ sộ one year. Negative dose-related effects were seen. These include decreased mean survival time, decreased number of births and progeny reaching an appropriate age for weaning. No evidence of carcinogenesis was found in 1-year studies Label. At daily doses of 0.24 g/kg/day given for 100 days đồ sộ albino rats, ASA led đồ sộ signs đồ sộ excessive thirst, aciduria, diuresis, drowsiness, hyperreflexia, piloerection, changes in respiration, tachycardia, followed by soft stools, epistaxis, sialorrhea, dacryorrhea and mortality during hypothermic coma in the second study month Label.

Use in pregnancy and lactation

While teratogenic effects were observed in animals nearly lethal doses, no evidence suggests that this drug is teratogenic in humans Label. It is advisable, however, đồ sộ avoid ASA use the first and second trimester of pregnancy, unless it is clearly required. If acetylsalicylic acid containing drugs are ingested by a patient attempting đồ sộ conceive, or during the first and second trimester of pregnancy, the lowest possible dose at the shortest possible duration should be taken Label. This drug is contraindicated in the 3rd trimester of pregnancy Label.

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Pathways
PathwayCategory
Acetylsalicylic Acid kích hoạt PathwayDrug action
Pharmacogenomic Effects/ADRs Browse all" title="About SNP Mediated Effects/ADRs" id="snp-actions-info" href="javascript:void(0);">
Interacting Gene/EnzymeAllele nameGenotype(s)Defining Change(s)Type(s)DescriptionDetails
Cytochrome P450 2C9CYP2C9*3(C;C) / (A;C)C AlleleEffect Directly StudiedPatients with this genotype have reduced metabolism of acetylsalicylic acid.Details
Leukotriene C4 synthase---(A;C) / (C;C)C alleleADR Directly StudiedThe presence of this genotype in LTC4S may indicate an increased risk of chronic urticaria when treated with acetylsalicylic acid.Details
Integrin beta-3GPIIIa PlA2(C;C) / (C;T)T > CEffect Directly StudiedPatients with this genotype have increased resistance đồ sộ the anti-thrombotic effects of aspirin.Details
Cytochrome P450 2C9CYP2C9*6Not Available818delAEffect InferredPoor drug metabolizer, lower dose requirementsDetails
Cytochrome P450 2C9CYP2C9*15Not Available485C>AEffect InferredPoor drug metabolizer, lower dose requirementsDetails
Cytochrome P450 2C9CYP2C9*25Not Available353_362delAGAAATGGAAEffect InferredPoor drug metabolizer, lower dose requirementsDetails
Cytochrome P450 2C9CYP2C9*35Not Available374G>T / 430C>TEffect InferredPoor drug metabolizer, lower dose requirementsDetails
Cytochrome P450 2C9CYP2C9*2Not Available430C>TEffect InferredPoor drug metabolizer, lower dose requirementsDetails
Cytochrome P450 2C9CYP2C9*4Not Available1076T>CEffect InferredPoor drug metabolizer, lower dose requirementsDetails
Cytochrome P450 2C9CYP2C9*5Not Available1080C>GEffect InferredPoor drug metabolizer, lower dose requirementsDetails
Cytochrome P450 2C9CYP2C9*8Not Available449G>AEffect InferredPoor drug metabolizer, lower dose requirementsDetails
Cytochrome P450 2C9CYP2C9*11Not Available1003C>TEffect InferredPoor drug metabolizer, lower dose requirementsDetails
Cytochrome P450 2C9CYP2C9*12Not Available1465C>TEffect InferredPoor drug metabolizer, lower dose requirementsDetails
Cytochrome P450 2C9CYP2C9*13Not Available269T>CEffect InferredPoor drug metabolizer, lower dose requirementsDetails
Cytochrome P450 2C9CYP2C9*14Not Available374G>AEffect InferredPoor drug metabolizer, lower dose requirementsDetails
Cytochrome P450 2C9CYP2C9*16Not Available895A>GEffect InferredPoor drug metabolizer, lower dose requirementsDetails
Cytochrome P450 2C9CYP2C9*18Not Available1075A>C / 1190A>C  … show all Effect InferredPoor drug metabolizer, lower dose requirementsDetails
Cytochrome P450 2C9CYP2C9*26Not Available389C>GEffect InferredPoor drug metabolizer, lower dose requirementsDetails
Cytochrome P450 2C9CYP2C9*28Not Available641A>TEffect InferredPoor drug metabolizer, lower dose requirementsDetails
Cytochrome P450 2C9CYP2C9*30Not Available1429G>AEffect InferredPoor drug metabolizer, lower dose requirementsDetails
Cytochrome P450 2C9CYP2C9*33Not Available395G>AEffect InferredPoor drug metabolizer, lower dose requirementsDetails