MEDICATIONS - Medicine for Mountaineering and Other Wilderness Activities - page 513

in 1915. This drug was considered such an important product that the German company
Bayer, which gave the compound its name, was forced to give up its trademark by the
Treaty of Versailles in 1919.
However, aspirin is no more effective than acetaminophen or ibuprofen and cannot be
recommended as a mild analgesic, particularly for wilderness use, because it is such a
strong gastric irritant. A study at a major university medical center found that over 90 per-
cent of the individuals hospitalized for gastrointestinal bleeding had been taking aspirin.
Combination with other drugs, except codeine, offers no significant analgesic benefits,
but acetaminophen and codeine is just as effective and does not have such adverse gastric
effects.
Aspirin is a prostaglandin inhibitor that helps prevent the aggregation of platelets and
the formation of blood clots. Doses of approximately 81 mg (“baby aspirin”) once a day
have been found to clearly reduce the incidence of myocardial infarction, but that dose is
too small to provide significant analgesia for adults. All aspirin, even baby aspirin, should
be enteric coated to reduce damage to the stomach.
The other use for which aspirin can be clearly recommended is one-half to one adult
aspirin tablet after the onset of angina or one adult tablet after the onset of a myocardial
infarct or a stroke ( Chapter 17: Heart and Blood Vessel Disorders ) .
Precautions: Aspirin is poisonous when taken in large quantities. In the United States
it is one of the two most common causes of poisoning in children (the other is acet-
aminophen, Tylenol®). Aspirin, particularly flavored “children's aspirin,” must be inac-
cessible to children, as must all medications.
Becauseaspirinissuchastronggastricirritant,personswithpepticulcersorrelateddis-
orders, including indigestion and gastroesophageal reflux disease (GERD), should not use
this drug. The addition of buffering agents or antacids does not increase analgesic potency
and reduces gastric irritation only slightly.
Acetaminophen
Acetaminophen (Tylenol® and others, and known as paracetamol outside the United
States) is a minor analgesic that is just as effective as aspirin for relieving minor pain and
reducing fever. However, acetaminophen has much less tendency to cause stomach irrit-
ation and does not increase the risk of gastric bleeding. Increasing the dose above three
standard or two extra-strength tablets does not provide additional analgesia.
Precautions: Acetaminophen in large quantities (10 to 15 gm) produces severe liver
damage. At one time it was the drug most commonly used for suicide in Great Britain.
These deaths are distressing because the individuals linger for about a week before dying
ofliverfailureandnoeffectivetherapyisavailable.Treatmentforanoverdosemustbeini-
tiated within a few hours after the drug has been ingested to be effective. This medication
should be used with caution for individuals known to have liver disease.