The basis of the mechanism of action of acetylsalicylic acid (ASA) is irreversible COX inhibition, resulting in blocked synthesis of thromboxane A2 and platelet aggregation is inhibited. It is believed that ASA has other mechanisms of inhibition of platelet aggregation, which expands the scope of its application in various vascular diseases. ASA also has anti-inflammatory, analgesic, antipyretic effect.
Pharmacokinetics Following oral aspirin is absorbed in the upper small intestine. Maximum plasma concentration is observed after an average of 3 hours after ingestion of the drug.Acetylsalicylic acid is partially metabolized in the liver with the formation pronabolin side effects of less active metabolites. It reports the news, in an unmodified form, and the form of metabolites; half-life of acetylsalicylic acid is about 15 minutes for the metabolite – about 3 hours.
Indications Prevention of acute myocardial primobolan results infarction in the presence of risk factors (eg, diabetes mellitus, hyperlipidemia, hypertension, obesity, smoking, old age), and recurrent myocardial infarction.
- Unstable angina.
- Prevention of stroke (including patients with transient ischemic attack).
- Prevention of transient ischemic attack.
- Prevention of thromboembolism after surgery and invasive procedures on vessels (eg, coronary artery bypass grafting, carotid endarterectomy, arterio-venous bypass, angioplasty, carotid arteries).
- Prevention of deep vein thrombosis and pulmonary artery and its branches (for example, after prolonged immobilization resulting from surgical large)Contraindications
- Hypersensitivity to ASA to excipients of the drug and other NSAIDs.
- Erosive and ulcerative lesions of the gastrointestinal tract; gastrointestinal bleeding.
- Hemorrhagic diathesis.
- Asthma induced by intake of salicylates and NSAIDs, the triad Fernand-Vidal, (a combination of asthma, recurrent nasal polyposis, and paranasal sinuses and intolerances ASA).
- The combined use with methotrexate 15 mg per week or more.
- Pregnancy (I and III trimester) and lactation.
- Age 18 years, Use with caution – for gout;hyperuricemia;a history: ulcerative lesions of the gastrointestinal tract or gastrointestinal bleeding, kidney and liver failure, asthma, chronic respiratory diseases, hay fever, nasal polyposis, allergic reactions to other drugs stanoxyl 10;in the II trimester of pregnancy;in combination with methotrexate at a dose less than 15 primobolan results mg per week;Vitamin K deficiency and glucose-6-phosphate dehydrogenase.Pregnancy The use of high doses of salicylates in the first 3 months of pregnancy is associated with an increased rate of fetal defects (cleft palate, heart defects). In the II trimester of pregnancy salicylates can be given only on the basis of strict risk assessment and benefit. In the last trimester of pregnancy salicylates in high doses (more than 300 mg / day) cause inhibition of labor, premature closure of the ductus arteriosus in the fetus, increased bleeding in the mother and fetus, and assignment just before birth can cause intracranial hemorrhage, especially in premature infants. Appointment of salicylates in the last trimester of pregnancy is contraindicated.
Application lactation salicylates and their metabolites in small amounts into breast milk. Accidental intake of salicylates during lactation is not accompanied by the development of adverse reactions in children and does not require stopping breastfeeding. However, long-term use of the drug or to appoint him to a high dose of breast-feeding should be discontinued immediately.
Dosing and Administration The tablets should be taken orally before meals, drinking plenty of fluids. The drug is intended for long-term use. The duration of therapy is determined by the attending physician. Prevention of suspected acute myocardial infarction 100-200 mg / day (the first tablet must be chewed for faster absorption). Prevention of new-onset acute myocardial infarction in the presence of risk factors 100 mg / dayProphylaxis of recurrent myocardial infarction. Unstable angina. Prevention of stroke and transient ischemic attack. Prophylaxis of thromboembolic complications after surgery or invasive investigations 100 – 300 mg / day, prophylaxis of deep vein thrombosis and pulmonary embolism and its branches 100-200 mg / day
Side effects: Allergic reactions: urticaria, angioneurotic edema. Immune system: anaphylactic reactions. Gastrointestinal tract: nausea, heartburn, vomiting, pain in the stomach, the gastric mucosa and duodenal ulcers, including perforation, gastrointestinal bleeding ., increased activity of “liver” enzymes Respiratory system: bronchospasm. hemopoiesis system: increased bleeding, anemia (rare). Central nervous system: dizziness, tinnitus.
Overdose Symptoms of overdose of moderate severity: nausea, vomiting, tinnitus, hearing loss, dizziness, confusion. Treatment: reduction in dose
Symptoms of severe overdose: fever, hyperventilation, ketosis, respiratory alkalosis, coma, cardiovascular and respiratory insufficiency, severe hypoglycemia. Treatment: immediate hospitalization in specialized departments for emergency therapy – gastric lavage, determination of the acid-alkaline balance, alkaline and forced alkaline diuresis, dialysis, administration of solutions, activated carbon, symptomatic therapy. When conducting alkali diuresis values necessary to achieve a pH between 7.5 and 8. Forced diuresis alkali should be performed when the salicylate concentration in plasma is greater than 500 mg / l (3.6 mmol / L) in adults and 300 mg / L (2, 2 mmol / l) in children.
Interaction with other drugs With simultaneous primobolan results use of ASA enhances the effect of the following medicines:
- methotrexate by reducing renal clearance and displacement of its association with proteins;
- heparin and indirect anticoagulants due to dysfunction of platelets and displacing anticoagulants from binding with proteins;
- thrombolytic and antiplatelet agents (ticlopidine);
- digoxin due to the reduction of its renal excretion;
- hypoglycemic agents (sulfonylureas and insulin) hypoglycemic properties by itself in high doses of ASA and sulfonylurea derivatives of displacement due to the proteins;
- valproic acid due to displacement from its association with proteins. An additive effect was observed when taken with alcohol ASA. ASA reduces the effect of uricosuric agents (benzbromaron) due to competitive tubular elimination of uric acid. Leveraging the elimination of salicylates, systemic glucocorticosteroids (GCS) weaken their effect.Special instructions: The drug should be used when prescribing physician. ASA may provoke bronchospasm and induce asthma attacks or other hypersensitivity reactions. Risk factors include the presence of asthma history, hay fever, nasal polyposis, chronic respiratory diseases and allergic reactions to other drugs (eg, skin reactions, pruritus, urticaria). ASA may cause bleeding of varying severity during and after the surgical interventions. The combination methenolone enanthate of ASA with anticoagulant, thrombolytic and antiplatelet drugs is accompanied by an increased risk of bleeding. ASA in low doses can trigger the development of gout in susceptible individuals (with a reduced excretion of uric acid). The combination of ASA with methotrexate is accompanied by an increased incidence of side effects of hematopoiesis . High doses of ASA have a hypoglycemic effect, it must be borne in mind when assigning his patients with diabetes receiving hypoglycemic medications. when combined with the appointment of the SCS and salicylates should be remembered that during treatment the level of salicylate in the blood is reduced, and after the abolition of GCS possible overdose salicylates. We do not primobolan results recommend the combination of ASA with ibuprofen, because the latter impairs beneficial effect Aspikora ® on life expectancy. Excess doses of ASA carries a risk of gastrointestinal bleeding. Overdose is especially dangerous in elderly patients. With the combination of ASA with alcohol increased the risk of damage to the mucous membrane of the gastrointestinal tract and prolongation of bleeding time.