Frequently Asked Questions
Prescription medication is prescribed by our qualified doctors at Morningside, Parkhurst, Bedfordview, Fourways, West Rand and Illovo clinics. In Pretoria at Irene and Brooklyn as well as in the Western Cape at Cape Quarter, Claremont, Constantia, Stellenbosch, Paarl and Willowbridge branches and KwaZulu-Natal at Umhlanga and Durban.
The term "prescription" is used to differentiate it from over-the-counter drugs, for which you do not need a prescription.
A prescription (℞) is a health-care programme that governs the plan of care for an individual patient and is implemented by a qualified practitioner. This qualified practitioner can either be a physician, dentist, nurse practitioner, pharmacist, psychologist, or other health care provider. Prescriptions may ask of the patient (or caretaker, nurse, pharmacist, physician or other therapist) to execute certain orders. As a result prescriptions have legal implications, as they may indicate that the prescriber takes responsibility for the clinical care of the patient and in particular for monitoring efficacy and safety. As medical practice has become increasingly complex, the scope of meaning of the term "prescription" has broadened to also include clinical assessments, laboratory tests, and imaging studies relevant to optimizing the safety or efficacy of medical treatment.
There is a common thread which links aspirin's beneficial effects on colorectal cancer, skin cancer, and Alzheimer's disease by its remarkable ability to reduce excess inflammation and promote healthy blood flow in affected areas.
Prostaglandins are hormone-like substances which are produced throughout the body. These cells are involved in fever, inflammation, and pain, as well as thromboxanes (which help regulate blood vessel tone), platelet aggregation, and clot formation.
The fatty acid arachidonic acid is transformed into prostaglandins and thromboxanes through the action of the cyclooxygenase (COX) enzymes. Aspirin has the function to irreversibly disable the COX enzymes so that they can no longer produce prosta-glandins and thromboxanes. If prostaglandin and thromboxane production is reduced, aspirin has the ability to decrease inflammation, pain, fever, and blood clotting.
With ageing individuals it is common for them to experience inflammation more often, as well as a greater occurrence of undesirable blood-clotting trends. It is believed increased exposure to oxidative stress and greater levels of pro-inflammatory mediators may lead to increased inflammation and blood-clotting tendencies. Aspirin's demonstrated ability to reduce inflammation may play a key role in helping to counteract many of the adverse biochemical changes that accompany aging. These very same properties also make aspirin a powerful weapon against many major diseases, including cardiovascular disease and cancer.
Because Aspirin has the ability to reduce pain, fevers, inflammation and blood clotting, it has become one of the most widely used medications in the world. It has been found in animal studies that Aspirin has also been shown to prevent atherosclerosis, though none of its known mechanisms of action would seem to account for this. In a new study, though, researchers have uncovered the mechanism that may explain aspirin's ability to prevent arterial plaque build-up.
Using cell culture and mouse models, it was observed that aspirin, specifically its active by-product salicylate, can greatly increase the expression of two proteins: paraoxonase 1 (PON1) and apolipoprotein A1 (ApoA1). Both of these proteins are beneficial components of the HDL complex, the "good cholesterol" that helps prevent atherosclerosis.
ApoA1 removes bad cholesterol from the bloodstream, while PON1 is an antioxidant that breaks down toxic lipid peroxides.
The researchers also noted that the heightened expression of PON1 was accompanied by an increase in a receptor called AHR (aryl hydrocarbon receptor); this was intriguing as a chemical known to attach to AHR is resveratrol, the "heart healthy" component of red wine.
Endothelial dysfunction: Health Renewal has repeatedly discussed the lethal dangers of endothelial dysfunction, the key underlying factor in the progression of atherosclerosis, or hardening of the arteries. Endothelial dysfunction occurs when the blood vessel linings can no longer dilate in response to demands for increased blood flow. Emerging studies indicate that aspirin may protect against heart disease in part by improving endothelial function.
Clot Prevention: The heart depends on its coronary arteries for the oxygen supply that fuels this most vital of organs. When normal blood flow through the arteries leading to the heart are slowed or interrupted, through blood clots or plaque build-up, it can lead to coronary heart disease. It is thus vital to prevent clots, and aspirin can help with this and prevent heart attacks. By irreversibly blocking production of the clot-promoting bio-chemicals known as thromboxanes, aspirin prevents platelets in the blood from latching on to each other and forming a clot. A platelet has a life span of 10 days, and aspirin permanently impairs the platelet's clotting ability. Aspirin helps blood flow more smoothly past any plaque that is narrowing an artery, and if a plaque ruptures, aspirin will reduce the likelihood of a clot clinging to it.
Anti-inflammatory action: Aspirin can also help prevent heart disease through its anti-inflammatory action. One of the things inflammation can cause if accumulation of plaque in the arteries, which can lead to various other diseases. The growth of plaque can obstruct blood flow through the arteries. A heart attack can be triggered if a plaque ruptures due to inflammation.
There are two theories from America as to when it's best to start with preventative aspirin medication:
According to American US Preventative Service Task Force, aspirin's proven benefits are reason enough for people to start using it if they have at least a 6% chance of developing coronary heart disease in the next 10 years.
By contrast, the American Heart Association recommends aspirin for people whose 10-year risk of developing coronary heart disease is 10% or higher, as long they have no medical contraindications for taking the drug.
A doctor at Health Renewal can help you calculate your cardiovascular risk based on factors such as tobacco use, cholesterol and blood pressure.
Health Renewal recommends that people who have already had a heart attack (or other episode of heart disease) discuss aspirin therapy with their doctor as part of a strategy to prevent future problems. Health Renewal also suggests that people with no previous history of cardiovascular disease, but who are nevertheless at high risk for heart disease, strongly consider aspirin therapy in consultation with their personal physician. The recommended dose for preventing heart-related problems is 81-325 mg daily. Speak with your doctor about your personal needs before beginning aspirin therapy, and please do not self-medicate.
Once your risk factors for stroke (such as hypertension, high cholesterol, diabetes, or smoking), start adding up you and your doctor need to discuss aspirin therapy. This becomes more important as you grow older and advance into age groups that bear a heavier stroke risk. If you have suffered a haemorrhagic stroke, aspirin should not be used. In general, 81-325 mg of aspirin daily is used as part of a stroke-prevention program.
Caution: Individuals with allergies to aspirin or other salicylates should not use aspirin. People with a history of bleeding disorders, haemorrhagic stroke, asthma, or ulcers should speak with a Doctor before using aspirin. Consult a physician before using aspirin in combination with over-the-counter or prescription medications. Children and teenagers with symptoms of flu or chicken pox should not take aspirin.
The brain requires a constant supply of oxygen from freshly flowing blood to convert glucose into energy. If a patient suffers from a stroke, the blood flow to part of the brain is cut off, and the damage from this interruption can cause death, disability, impaired speech and myriad other adverse effects.
The most common type of stroke (known as ischemic stroke) occurs when an artery becomes blocked, which limits the blood supply to areas of the brain. This type of stroke accounts for about 80% of stroke cases. The remaining percentage of stroke cases are cases of haemorrhagic stroke, which is caused by a blood vessel rupturing and spilling blood into the brain usually due to high blood pressure.
NOTE: Aspirin plays vastly different roles in these two types of stroke.
Aspirin helps to decrease the risk of ischemic stroke by keeping blood platelets from sticking together to form a clot, so that blood continues to flow past any narrowed spots in the arteries that feed the brain. However, some studies suggest that taking aspirin may cause a slight increase in a person's chance of having a hemorrhagic stroke.
It has been suggested on various occasions that aspirin is underutilized in the prevention, and management, of other conditions affecting the cardiovascular system. Doctors know that people who have conditions such as metabolic syndrome, kidney dialysis, peripheral arterial disease, and angina have elevated risks of cardiovascular disease and heart attacks. Research findings in recent years indicate that aspirin therapy may help to mitigate the elevated cardiovascular disease risk experienced in these patient populations.
New evidence is helping to explain additional health benefits of aspirin. Researchers in Canada, Scotland and Australia have discovered that salicylate, the active ingredient in aspirin, directly increases the activity of the protein AMPK (AMP-activated protein kinase), a key player in regulating cell growth and metabolism.
AMPK which is considered a cellular fuel-gauge is switched on by exercise and the commonly used anti-diabetic medication metformin. These findings are important as a large clinical trial is currently underway testing whether salsalate (a well-tolerated aspirin derivative), can prevent Type 2 diabetes.
Salicylate, which is derived from willow bark, and is the active ingredient in aspirin, is believed to be one of the oldest drugs in the world with first reports of its use dating back to an Egyptian papyrus in 1543 BC. An anti-inflammatory drug first used as a painkiller more than a century ago, aspirin is now given to people at risk of heart attacks and strokes as well as patients with vascular disease.
Activating AMPK: Reports have stated that taking an aspirin every day may significantly reduce the risk of various forms of cancers, and prevent tumors from spreading. The question remains though: "How does this anti-cancer benefit occur?". Many recent studies show that metformin may be important for cancer prevention, in a similar fashion it is coming to light that aspirin might do the same. Further studies showed that salicylates and metformin share a commonality in their ability to activate AMPK.
Chronic inflammation: This condition can pave the way for many deadly diseases, including cancer. Inflammation has a part to play when it comes to encouraging normal cells to become cancerous. As an example, inflammation generates free radicals that can damage the genetic material responsible for regulating normal cell death and reproduction. Most research that has been done focussed on aspirin's effects, specifically against colorectal cancer, and from this came evidence which indicates that aspirin may also markedly reduce the risk of cancers of the skin, breast, ovary, lung, and other organs.
Inhibiting COX enzymes: Aspirin offers protection against cancer through its effects on the COX enzymes. While the COX-1 enzyme promotes blood clotting and helps protect the stomach lining, COX-2 participates in harmful inflammation and cancer. Aspirin inhibits both types of COX enzymes, which may account for its protective effects against various cancers. The use of anti-inflammatory therapies, including natural therapeutics such as curcumin and green tea may help prevent and fight cancer.
Aspirin may protect woman from both breast & ovarian cancers. Research from a 2005 study on breast cancer, reported that women who used more than 100 mg of aspirin on a frequent basis (for 90 days or more) during the year prior to mammogram testing had a lower risk of breast cancer than infrequent users or non-users of aspirin. A similar study was done on woman with ovarian cancer in 2006 to show how aspirin use can lower the risk of ovarian cancer. The research team noted that women who used any form of NSAIDs, such as aspirin, within the previous five years had a reduced risk of developing ovarian cancer.
Aspirin has the ability to protect the body against colon cancer. In a double-blind study of 2003, researchers gave large groups of 350 adults a daily dose of either 81mg, or a placebo pill, for three years. At the onset of the study all the subjects had had colon polyps removed in the past, but were at that stage free of polyps. It is thought that many colon cancers develop from polyps. The subjects continued with their aspirin/placebo medication for approximately three years, after which they underwent another colonoscopy to determine how many (new) growths were present. The subjects who took the 81-mg dose of aspirin revealed to have had 19% fewer polyps than those who only took the placebo tablet. This study's findings allowed researchers to make the conclusion that low-dose aspirin had a modest effect in reducing the incidence of potentially pre-cancerous polyps.
To further motivate these findings another study examined 635 patients with a history of colorectal cancer. Half of those patients took 325 mg of aspirin a day, while the other half took a placebo. After roughly a year of patients on the treatment plan, each group underwent a colonoscopy to check for polyp growth. These results were even more impressive than the previous study: subjects who took the aspirin medication had a 35% lower risk of polyps than those who took placebo. In addition, it took longer for polyps to develop in the subjects who took aspirin. These findings suggest an important role for aspirin in preventing colon cancer.
Aspirin can lower an individual's risk of skin cancer. Recent research done in Australia offers compelling evidence that aspirin use protects the skin against cancer. It was found that people who regularly used aspirin (and other non-steroidal anti-inflammatory drugs (NSAIDs) were less likely to develop potentially cancerous growths such as squamous cell carcinoma and actinic keratosis (a pre-cancerous skin condition linked to excessive sun exposure).
If a person suffers from Alzheimer's disease it will cause changes in the individual's brain appearance (causing the brain tissue to actually shrink), and it will alter their mental abilities. With the regular use of anti-inflammatory drugs, particularly that of Aspirin, it can be a contributing factor to reduce the occurrence of Alzheimer's disease and even improve the protection of the patient's cognitive function. It has been found that if the COX enzyme can be subdued it could reduce prostaglandins. This in turn could reduce the excess stimulation caused by glutamate, thus protecting cells against inflammation and neurodegenerative disease.