(OTC NSAIDS)

Aspirin and other NSAIDs, for example, ibuprofen (e.g., Motrin, Advil) and naproxen (e.g., Aleve), are widely used to treat fever, pain, and inflammatory conditions such as arthritis, tendonitis, and bursitis. In addition to its effects on pain, fever, and inflammation, aspirin also has an important inhibitory effect on platelets in the blood. This antiplatelet effect is used to prevent blood clot formation inside arteries, particularly in individuals who have atherosclerosis of their arteries or are otherwise prone to develop blood clots in their arteries.

Of the 80 million aspirin tablets Americans take each day, most are taken not for everyday aches and pains but to reduce the risk of heart disease, according to aspirin manufacturer Bayer Corp.

As summarized in FDA's 1998 rule and in the updated professional labeling for aspirin, the 100-plus-year-old drug has been shown to reduce the risk of the following medical problems:

• stroke in those who have had a previous stroke or who have had a warning sign called a transient ischemic attack (mini-stroke)

• heart attack in those who have had a previous heart attack or experience angina (chest pain)

• death or complications from a heart attack if the drug is taken at the first signs of a heart attack

• recurrent blockage for those who have had heart bypass surgery or other procedures to clear blocked arteries, such as balloon angioplasty or carotid endarterectomy.

Although aspirin is a familiar and readily available drug, people shouldn't take it for its cardiovascular benefits without discussing the risks of long-term use with a doctor, cautions Charles H. Hennekens, M.D., chief of preventive medicine at Brigham and Women's Hospital in Boston. "If someone feels they're a candidate, they should talk to their doctor in making the judgment if the benefits outweigh the risks."

The same quality that gives aspirin its potential benefit--its ability to inhibit clotting of the blood--may increase the risk of excessive bleeding, including the possibility of bleeding in the brain. Some other possible risks are:

• Stomach irritation. Aspirin can irritate the stomach lining and cause heartburn, pain, nausea, vomiting, and, over time, more serious consequences such as internal bleeding, ulcers, and holes in the stomach or intestines. Chronic alcohol users may be at increased risk of stomach bleeding, as well as liver damage, from aspirin use.

• Ringing in the ears. At high doses, aspirin may cause temporary ringing in the ears and hearing loss, which usually disappear when the dose is lowered.

• Allergy. Facial swelling and sometimes an asthma attack may occur in the two out of 1,000 people who are allergic to aspirin, according to the Mayo Clinic in Rochester, Minn.

Other Uses

Aspirin is sometimes used to treat rheumatoid arthritis, juvenile rheumatoid arthritis, osteoarthritis, and some other rheumatological diseases. Aspirin labeling was updated in 1998, and now provides information on specific dosing, side effects, and toxicity of aspirin for these conditions.

More potential medical uses for aspirin are still under study--everything from treating migraines and colon, ovarian and breast cancer to improving brain function. Could an aspirin a day help you retain your memory as you age by preventing clogging of the arteries in the brain? It remains to be proven, but early studies suggest it's possible.

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