ASPIRIN - LIKE DRUGS

Introduction
Aspirin like drugs are usually ineffective against sharp pain, which is caused by direct stimulation of sensory nerves, but are effective in the dull pain of inflammation where prostaglandins have apparently sensitized the peripheral nerve endings. When used in post operative analgesia, they are effective in the management of low to moderate pain, particularly pain associated with inflammation. Aspirinlike drugs provide only symptomatic relief from inflammation and pain associated with this certain types of disease process.

Side effects
Gastric or intestinal ulceration which can be accompanied by secondary anemia from the resultant blood loss is a side effect. Platelet function is disturbed because aspirinlike drugs prevent the formation by the platelets of thromboxane. Hypersensitivity to aspirin is a contraindication to therapy with any of the aspirin-like drugs.

Uses
Clinical application of these drugs is the management of inflammatory conditions such as those seen in rheumatoid arthritis, osteoarthritis and ankylosing spondylitis

SALICYLATES

Acetylsalicylic Acid (Aspirin)

Effective analgesic against mild to moderate discomfort but not against severe pain. Dosages available: 75 mg and 325 mg tablets for oral use 65 mg, 120 mg, 325 mg fecal suppositories Adult dosage for pain and fever: 65 mg every 4 hours Analgesic-antipyretic dosage for children: 65 mg/kg/24 hours divided into 4 to 6 doses.

Diflunisal (Dolobid)
Derivative of salicylic acid. Indicated for mild to moderate pain. It is the longest acting drug in the aspirin-like category.

Available dosage: 250 mg and 500 mg tablet for oral use Initial adult dose: 1000 mg followed by 500 mg every 8 to 12 hours

Para-aminophenol derivative
Effective alternatives to aspirin Acetanilid(Antifebrin) is parent member of this group of drugs Removed from clinical use because of its excessive toxicity

Phenacetin (Acetophenetidin)
Deethylated from acetaminophen. Weak analgesic properties and toxic properties. Once linked to renal papillary necrosis and urinary tract transitional cell carcinoma. Depresses the CNS. Drowsiness aand slight euphoria have been observed after small doses.

Acetaminophen (Tylenol, Tempra, Datril)

Equipotent and equianalgesic with aspirin Much Less anti-inflammatory activity than aspirin and does not inhibit platelet aggregation. Overdose can result in hepatic necrosis and acute hepatic failure. Nephrotoxicity is not usually a problem

 Available forms: 100 mg/ml drops 120 mg/5ml syrup 325 mg and 500 mg tablets and capsules 120 mg, 325 mg and 650 mg rectal suppositories. Adult dose: 650 mg every 4-6 hrs Children dose: under 1 year of age, 60 mg 1 to 3 years, 60 to 120 mg 3 to 6 years, 120 mg Over 6 years of age, 240 mg.

OTHER ASPIRIN-LIKE COMPOUNDS:

Ibuprofen (Motrin,Rufen)
Is a member of the phenylalkanoic acid derivatives. Has analgesic and anti-inflammatory properties that are superior to aspirin 3.5 times as potent as aspirin for pain relief following surgery for dental impactions. Available doses: 400 mg and 600 mg tablets for oral use For mild to moderate pain is 400 mg to 600 mg every 4 to 6 hours.

Zomepirac (Zomax)
Recommended only as an analgesic, close structural relationship to tolmetin sodium (Tolectin) which is the treatment for arthritis Similar mechanism of action with aspirin More effective than nonnarcotic analgesic combinations Available dose:100 mg repeated every 4 to 6 hours

Mefenamic Acid (Ponstel)

Synthetic analgesic with antipyretic and antiinflammatory action Most serious side effects are gastrointestinal Available doses: 250 mg capsule Adult dosage: 500 mg initially followed by 250 mg every 6 hours.