[HN Gopher] The history behind aspirin 81 (2019)
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The history behind aspirin 81 (2019)
Author : hippich
Score : 45 points
Date : 2023-11-26 19:53 UTC (3 hours ago)
(HTM) web link (www.clinicalcorrelations.org)
(TXT) w3m dump (www.clinicalcorrelations.org)
| Plankaluel wrote:
| This seems to be a US (UK?) thing? At least here in the German
| speaking countries in Europe aspirin also has nice round numbers.
| A dosage for heart attack prevention is usually 100mg. Normal
| dose is 500mg
| boringuser2 wrote:
| That doesn't seem advisable.
|
| It seems like you'd want to base your choice on two main
| criteria:
|
| 1. The lowest effective dosage.
|
| 2. The dosage with maximum efficacy vis-a-vis what is studied
| in the literature.
|
| At a cursory glance, it seems like many studies compare a lower
| dosage of aspirin to a higher dosage (e.g. 75mg to 300+mg) and
| the lower dose tends to compare favorably.
|
| Having nice round numbers is of no benefit to a patient.
| wrs wrote:
| It's all "round numbers". 81mg is just 1.25 grains, a quarter
| of the normal 325mg dose which is just 5 grains. It's not
| like anyone did a clinical study to determine the effective
| dosage to two significant figures.
| Plankaluel wrote:
| Sure, but it seems like the US is doing the same for all
| other drugs except for aspirin so I assume it is not a huge
| problem?
| coldtea wrote:
| > _That doesn 't seem advisable_
|
| Has been working ok for hundreds of millions, so there's
| that.
|
| Almost all drugs are sold in "nice round numbers" anyway.
|
| Given that you can drop orders of magnitude in scale from
| grams to milligrams (or whatever) to suite the dosage
| calculation, nobody is going to notice the difference between
| X with decimal points and Y which is X rounded, as if 247.3mg
| was going to be optimal and 250 will be bad.
|
| The variability of what the patient actually needs (e.g. an
| adult male could be 1.55 and 50kg to 2.10 and 150kg but they
| usually just get the same dosage in the instructions - and
| for most drugs no doctor would bother to suggest a more
| fitting value) would be higher than any rounding error
| anyway, but in practice it hardly matters.
| saulrh wrote:
| > Having nice round numbers is of no benefit to a patient.
|
| At our current level of logistical sophistication, the
| benefit-to-the-patient is that they can get their medications
| at all.
|
| I agree that in a perfect world every prescription would
| start with a computation, based on body weight and historical
| susceptibility and suchlike, to determine _precisely_ the
| right dosage. However, I also don 't think we're there yet. I
| don't think that you can reasonably prescribe "take 6
| milliliters of this" or "take thirteen of these"; patients
| would mess that up reliably even if they were in perfect
| health and had perfect vision and perfectly stable hands. And
| we can't stock thirty different sizes of pill; each size of
| pill takes up already-limited shelf space, increases cost of
| packaging and logistics, and increases the likelihood of
| dosing error. So doctors _can 't_ yet prescribe precisely the
| dosage they should be able to. I'm sure that there are cases
| where they do - drugs with narrow therapeutic ranges
| administered in hospital settings where they can be
| _precisely_ dispensed by IV - but for stuff that 's being
| sent home with patients, we're just not there yet.
|
| (Sadly, even on-demand services like pillpack won't save us,
| because doctors can't depend on the availability of custom
| pill-stamping when they make a prescription - they _have_ to
| assume that the lowest-common-denominator pharmacy is being
| used to fill the prescription.)
|
| (In fact, going by the rate at which hospital mortality is
| attributed to dosing errors during administration, we haven't
| solved precision pharmacology _even under ideal
| circumstances_ and fundamental breakthroughs are required
| that will obsolete any current approach to dispensation of
| prescription medication.)
| potatopatch wrote:
| > Having nice round numbers is of no benefit to a patient.
|
| Patients benefit from simplicity just like practitioners,
| they have to do math like whether they've reached 1500mg in a
| day or need to split pills when there is an availability
| problem (for a dosage.)
|
| An optimal dose to be served to everyone is also a myth as
| dosing is calculated by weight, etc.
| traceroute66 wrote:
| > UK?
|
| Nope. Just a US thing.
|
| As you can see on the NHS (UK National Health Service)
| website[1]: The usual dose to prevent a heart
| attack or stroke is 75mg once a day (a regular strength tablet
| for pain relief is 300mg). The usual dose for pregnant
| women is either 75mg or 150mg, taken once a day. The
| daily dose may be higher, up to 300mg once a day, especially if
| you have just had a stroke, heart attack or heart bypass
| surgery.
|
| Also says similar in the BNF (British National Formulary)[2]
|
| [1]https://www.nhs.uk/medicines/low-dose-aspirin/how-and-
| when-t... [2]https://bnf.nice.org.uk/drugs/aspirin/
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