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Comment by benji-york | Hacker News Reader

> 8.0–31.2 g per day

That is surprising amount of aspirin.

I would go out on a limb and say it's a LOT of Asprin. I usually use "surprising" on HN because anything more specific gets criticized surprisingly often, but that is a ton of asprin

it's a veritable fuck-ton. the usual modern dose is 325mg.

The maximum daily dose is usually around 4g. 325mg is probably the dose in one tablet.

Doctor here: very rarely does any prescribe anything more than 325mg daily. Most people get 81mg daily. 325mg is considered high dose.

You are correct that it can be written for more, but the only indication you would prescribe a higher dose is as a pain or fever reducer, and we have more effective NSAIDs for that. Or tylenol (?NSAID).

I've personally never seen it given more than 325mg daily.

In the United States, 325mg is the amount in a single standard OTC pill. People often take two pills because of the old doctor's adage, "take two aspirin and call me in the morning".

81mg is marketed as low-dose (aka "baby aspirin"--because of the size or dose, not because it's intended for babies) and often prescribed as prophylaxis. But that's not particularly relevant wrt the maximum safe short-term dosage. The worst part of a flu usually only lasts a few days.

Here are the label directions from a bottle of generic aspirin as shown on Amazon (GoodSense Aspirin Pain Reliever 325 mg Coated Tablets, 100 Count).

  Drink a full glass of water with each dose. Adults and
  children 12 years and over: take 1 or 2 tablets every 4
  hours or 3 tablets every 6 hours, not to exceed 12 tablets
  in 24 hours. Children under 12 years: consult a doctor.

That's approx. 4 grams/day for OTC usage.

So what we have learned here is that whilst many years ago 8-30+ g daily dosage was either routine or at least proscribed in some cases, the routine upper limit is now much reduced because the side effects of taking Salicylate in such huge doses are worse than the symptoms or conditions that it was prescribed for.

However, it may be possible that the stuff might (in huge doses) cure or at least reduce something even worse than its own side effects. Then you are in the realms of a simple risk assessment where the failure mode is pretty horrid but that has to be weighed up against the alternatives if they even exist - all of which ... well you get the idea.

(IANAD)

The labels on over-the-counter, "adult low dose" aspirin recommend taking up to 48 81mg aspirin tablets (3.9g) per 24 hour period before checking with a doctor to see if that is okay. I was taking up to 1g per day at one point (for pain), thinking that it was a very low dose because of the labels. :/

https://dailymed.nlm.nih.gov/dailymed/image.cfm?id=93682&nam...

What do you mean by (?NSAID) after tylenol?

Because acetaminophen/paracetamol is only weakly anti-inflammatory, so you may or may not consider it an NSAID, I assume.

Isn't tylenol fairly dangerous?

https://www.thisamericanlife.org/radio-archives/episode/505/...

Toxic to the liver in large or frequent dosage.

> I've personally never seen it given more than 325mg daily.

Really? Lortab 5/500?

is tylenol, not aspirin. unless the formulation has changed.

I'm not sure of any generic formulations of hydrocodone that are made with aspirin and widely prescribed.

there are some like Percodan but those are 5/325 AFAIK and oxycodone, not hydrocodone.

I'm not a doctor though, just a nerd.

Lortab has all sorts of variations, 500 mg aspirin being one: https://www.drugs.com/imprints/500-4519.html

Acetaminophen != NSAID

In the US. It's higher in France, for example.

Wild guessing: maybe it contained much less then the xx grams of (pure) aspirin? The rest could have been filler as the tech wasn't as precise as today.

you know what they say, ten aspirin tablets a-day keeps the emergency room busy.

Even a small amount of Asprin, if taken regularly, will mess up your stomach in my experience!

I guess not everyone is sensitive to it, but for me I've avoided Asprin (and Ibuprofen, another NSAID drug) for years because of this.

What's 'regular?'

I use ibprufen exclusively, without stomach issues.

But not daily. I probably take it once per week on average. Usually when lacking caffeine has caused a headache. Or eyestrain, occasionally.

Those are probably the issues I should fix, though.

>But not daily. I probably take it once per week on average.

My grandmother shits and pukes blood if she takes NSAIDs of any kind, from long-term, daily misuse. I'm not exaggerating even a little bit, I wish I was.

A direct result of being denied access to proper pain relief, mind you, mainly because she lived her entire life without health insurance. Until she turned 65 and qualified for Medicare last year. I had to take every NSAID out of the house, and throw them away, because every time she ran out of opiates for pain relief she'd over-compensate with a handful of NSAIDs which resulted in some scary events, including coffee ground bowel movements which were in fact blood from her stomach. As well as constant vomiting, etc.

My grandfather is similarly damaged from being recklessly over-prescribed NSAIDs, namely 800mg ibuprofen up to 8 times per day, resulting in shitting and puking up blood. He can't have more than an 81mg aspirin now.

/anecdotal evidence

After surgery I was prescribed an NSAID called Naproxen. It's apparently much easier on the stomach than Ibuprofen, but has a very slightly higher chance of causing a heart attack or stroke.

I think this is one of those situations where they'd rather a thousand people be miserable and wreck their stomachs than one person drop dead and cause a lawsuit.

Add me to the anecdotal evidence there. A regular dose of ibuprofen and I can't eat and I throw up blood for a day..

Same here. I had an acute bleed from using NSAIDs, lost consciousness and came within an inch of dying. I now get extremely emotional when I see articles or comments recommending them without any disclaimer. There's a dangerous misconception that they are harmless (or even health promoting) if used at low / moderate doses.

Are you taking it with food? Because ibuprofen absolutely will cause GI bleeding if you take it without food, and yet most of the time there is no label on the bottle to warn you about this.

I had some back problems and was reliant on ibuprofen for a few years. By the time I stopped taking them, I had to choose between back pain/ not being able to walk, or throwing up blood and not being able to eat.

In the peak of my "strenuous exercise" and "age" graph, I was taking about 12 advil a day, with Zantac. Eventually that, combined with a bit too much drinking (0-3 drinks a day), culminated in a messed up stomach. But I easily can go 2-4 advil a day without a problem. I avoid it, these days, and typically take 1 or 2 every day or two.

In the military, "Vitamin M" (800mg of motrin/ibuprofen, about 4 advil) used to be heavily given for about anything multiple times per day!

That's a bit scary. Chronic use of NSAIDs has been associated with kidney cancer, and if that doesn't scare you, erectile dysfunction may, if you're a man. I'd go with Tylenol instead (carefully), although that has pretty serious liver risks too.

I've stopped taking either unless I have a strong reason. No more chronic use at all - yoga does more for pain relief long term, and I stopped playing soccer, and limit myself to lower impact sports. I'm sore enough after exercising without some 20 year asshole laying me out on the field ;)

Given the doctors seem to be telling everyone over 50 to take a daily aspirin, I would think that a goodly chunk of people aren't sensitive. It might be the low dose people are taking.

It's also possible that the heart benefits outweigh the side effects. A lot of medicine is just saying "this sucks but if you don't do it you'll die" and prescribing the least bad option.

As a Crohn's Disease patient, my GI doc advises me to avoid aspirin and Ibuprofen because of their effect on the digestive system. Acetaminophen is fine for this, but apparently requires some care itself because large doses can damage the liver.

I come from a long line of iron-stomachs who don't bat an eyelash at any of those. ;)

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