Aspirin is the most widely used medicine in the world, the Greatest medicine of All Time.

It started out as a tea made of willow or poplar bark, which contains a natural form of salicylic acid. Starting in 1838, salicylic acid was used as a powder dissolved in water to ease fever and discomfort from headache and arthritis pain. Unfortunately, it tasted terrible and often caused nausea and stomach pain.

In 1899, scientists from the German company Bayer developed an improved version of salicylic acid, called acetylsalicylic acid, which they trademarked as Aspirin®. One year later, Bayer introduced Aspirin as the world’s first water-soluble tablet, causing a revolution. Aspirin was everywhere, helping to relieve fever, headache, toothache, and muscular aches and pains.

Birchbark and wintergreen plants contain a compound similar to aspirin, methyl salicylate. Its strong characteristic aroma gives it the name wintergreen oil. Used in topical rubs for sore muscles, it is also available in Doan’s pills. Initially sold in the early 1900s, Doan's Kidney pills were marketed for back pain. Today's formulation contains methyl salicylate in a dose equivalent to 500mg of aspirin or acetaminophen.

In the United States, there are two strengths of aspirin: 81 mg strength, also called baby aspirin, and 325mg tablets. Aspirin tablets containing 325mg are approved by the Food and Drug Administration (FDA) for “the temporary relief of minor aches and pains associated with a cold, headache, backache, toothache, premenstrual and menstrual cramps; minor pain of arthritis; and reduction in fever."

The FDA also requires that all aspirin products include this statement on the label: Talk to your doctor or other healthcare provider before using this product for your heart.

Aspirin works to interfere with the action of specific cells in your blood called platelets. Platelets act to plug up blood vessels that are damaged and leak blood. Without enough platelets, you cannot stop bleeding and can bleed to death from minor injuries like bumps and cuts. Sometimes platelets clump up in the wrong places, blocking blood flow inside vessels in your heart and brain, causing a heart attack or stroke. Aspirin can help prevent that by interfering with how platelets form into clumps.

You can buy aspirin in several formulations: as an enteric-coated formula (Ecotrin®), two different buffered versions (Bufferin® and Alka-Seltzer®), combined with acetaminophen and caffeine (Excedrin® and Excedrin Migraine®), or plain (Bayer®), St. Joseph®.

One recent concern about aspirin is who should take it to prevent heart attacks and stroke. A study published in late 2018 in the New England Journal of Medicine showed that taking daily aspirin did NOT prevent stroke or heart attack in healthy patients over the age of 65. However,, it did increase the chances of experiencing stomach bleeding or bleeding into the brain, the most devastating type of stroke.

This suggests that taking daily aspirin should be limited to those whose risk of heart attack and stroke is high enough to justify the possibility of having severe bleeding.

In a survey published in 2019 of 14,000 adults 40 years old or older, 23% of people taking aspirin to prevent heart attack had no heart disease. In addition, 23% of those same people took a daily aspirin without their doctor's knowledge.  

Here are 5 Tips to Taking Aspirin Safely:

1. Ask your doctor FIRST. Aspirin does not prevent stroke and heart attack in healthy people with no previous stroke or heart attack or those who are not diabetic. Your doctor can tell you if you would benefit from taking it.
2. More is not better. It only takes an 81mg dose of aspirin to protect against stroke and heart attack. Higher doses can double your risk of bleeding in your brain or stomach.
3. Any aspirin product will work. Taking an enteric-coated or buffered aspirin version works just like plain aspirin. Unfortunately, it won't decrease your risk of bleeding.  
4. It’s safe to take without food. Taking aspirin with water is a good idea. You don't need food to "cushion your stomach" when taking an 81mg tablet of aspirin unless it bothers your stomach. The increased risk of stomach bleeding from aspirin is not from the tablet itself sitting in your stomach but from its generalized effects in your body.
5. Avoid using "full dose" aspirin if you take a blood thinner.

Taking aspirin for pain or fever increases your risk of bleeding if you take a blood thinner like clopidogrel (Plavix®), warfarin, Pradaxa®, Xarelto®, or Eliquis®. You should also avoid taking a daily aspirin unless your doctor recommends it.

Dr. Louise Achey, Doctor of Pharmacy, is a 43-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Get clear answers to your medication questions at her website and blog TheMedicationInsider.com.  2022 Louise Achey