THE NON-OPIOID ANALGESICS: ASPIRIN-INDICATIONS, GASTROINTESTINAL
Indications-Aspirin is indicated for the treatment of mild to moderate soft tissue pain and mild, moderate or severe cancer-related bone pain. Aspirin (or other NSAID) may be more effective than opioid analgesics for the treatment of bone pain, although for moderate or severe pain an opioid drug is often required as well.
Gastrointestinal-Symptoms of gastrointestinal toxicity occur in at least 20% of patients taking regular aspirin, and an even greater proportion can be shown to have increased gastrointestinal blood loss. The effects of aspirin range from mild inflammation and occult blood loss to mucosal erosion and ulceration which may cause serious bleeding and anaemia. Aspirin toxicity most frequently involves the stomach; the duodenum and oesophagus are affected less often.
Aspirin produces gastric toxicity by both direct local irritation and by inhibition of prostaglandin synthesis which leads to secretion of more acid and less cytoprotective mucous. The risk of gastrointestinal toxicity is greater in older patients, those with a history of peptic ulcer or gastric erosions, patients receiving treatment for longer periods and those concomitantly receiving corticosteroids.
Treatment to prevent gastrointestinal toxicity should be considered for all patients taking regular aspirin (or other NSAID). Antacids will reduce symptoms but not bleeding or erosions. Sucralfate or an H2-receptor antagonist will reduce the incidence of duodenal ulceration but have no effect on gastric erosions and ulceration. The synthetic prostaglandin analogue, misoprostol, is effective in preventing analgesic-induced gastric and duodenal ulceration and also promotes healing of established lesions.
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