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From: sxk29@po.CWRU.Edu (Susan Kretschmer)
Newsgroups: alt.folklore.urban
Subject: Re: Pill w/o Water Burns Hole In Throat?
Date: 2 Feb 1994 08:12:40 GMT

Ack! I miss reading afu for one day; I come back to 450-odd posts and yet more medical musing. Maybe I should just upload my bookshelf!

Okay...following info from Goodman and Gilman's _Pharmacological Basis of Therapeutics_, ISBN 0-08-040296-8 (p.9-20 on routes of administration and p.644-655 on aspirin). *This post may be in two parts due to the connect time limit on my net access*.

On Acid Confusion

(No..not that kind! Wrong thread...try the next one over!) Your basic aspirin is actually known as *acetyl*salicyclic acid. I lost the acetyl somewhere in the last post, probably near the pyloric valve. Regular old salicyclic acid, although it was the first headache-cure isolated from willow bark, is even nastier on your stomach than regular aspirin. In fact, it's so nasty that it (*and*, in a dazzling display of thread-tying, its close relative methyl salicyclate, or "oil of wintergreen") can both be applied externally as ointments, to treat WARTS! Cool, eh? So just apply wintergreen lifesavers by the light of the full moon...

Anyway, to address the original purpose of the thread, it's not all THAT farfetched to imagine aspirin being chemically irritating based on plain old salicyclic acid. However, that's why they stuck the acetyl on there, which makes it less irritating, and the pill without water still won't burn a hole in your throat.

The Magical Mystery Tour (or, How Does an Aspirin Get to a Headache?)

There are several sources of confusion here. (Well, it's Usenet, so there are lots, but anyway...) It does seem that if your head hurts, and you can somehow get aspirin to your head specifically you'll feel better faster. Unfortunately, there are a lot of reasons it won't work. Confusingly, there are a lot of interesting phenomena which make you think it should work...I'm going to answer these one at a time.

1. Can aspirin be absorbed through the gums?

Yes. As has been pointed out, drugs are indeed administered via the inside skin of your mouth. Nicorette chewing gum, and chewing tobacco itself, "just a pinch between the cheek and gum..." both work this way. The nicotine goes through the cells of the cheek and through those cells into nearby capillaries (teeny tiny blood vessels) and then into the veins, the heart, and then the heart will pump it all over the body from there. (Lee Boyle said almost exactly this in his post.)

The inside of the mouth is known as a *mucous membrane*, where capillaries are dense and chemicals can cross easily into the blood. The inside of the nose is also a mucous membrane, which explains why snorting cocaine gets it effectively into your circulation; same path as I just described. Rectal suppositories work the same way: the inside of the rectum is also a mucous membrane (hey, yet another thread here!).

2. So, will absorbing aspirin through my gums get it straight to my head?

Nope. It's gotta go through the heart and the rest of the body first. So, you may as well swallow it, cause stuff absorbed from the intestines goes to the heart too.

***Exception to the "you might as well swallow it" rule: Nitroglycerin

As people have noted here, nitroglycerin is given under the tongue. The reason for this has nothing to do with speed of absorption. It is due to something called the "first-pass effect" (Lee, is this ringing dim bells?) Stuff absorbed from the intestine gets routed to the liver to get detoxed before it's allowed to go to the heart and then everywhere else.

uh-oh....end of Part One...cont'd next post

--

Susie Kretschmer              "Don't ask me, I'm just improvising" 
CWRU School of Medicine                  -Rush, _Presto_

MSTP Class of 1998 Internet: sxk29@po.cwru.edu *VR .sig virus* DS, DNA, and taking names...

From: sxk29@po.CWRU.Edu (Susan Kretschmer)
Newsgroups: alt.folklore.urban
Subject: Re: Pill w/o Water Burns Hole In Throat?
Date: 2 Feb 1994 09:08:35 GMT

Grrr...I love Freenet. Really. *Sarcasm off. Maybe.*

In a previous article, sxk29@po.CWRU.Edu (Susan Kretschmer) says:

(before I was rudely interrupted by Freenet kicking me...)

>2. So, will absorbing aspirin through my gums get it straight to my head?
>
> Nope. It's gotta go through the heart and the rest of the body
>first. So, you may as well swallow it, cause stuff absorbed from the
>intestines goes to the heart too, before it gets to your head.
>
>***Exception to the "you might as well swallow it" rule: Nitroglycerin
>
> As people have noted here, nitroglycerin is given under the tongue.
>The reason for this has nothing to do with *speed of absorption*.

Well, actually, because nitroglycerin is very lipid-soluble, it is absorbed *very* quickly this way, so speed is part of it...

However, it is mostly
>due to something called the "first-pass effect" (Lee, is this ringing dim
>bells?) Stuff absorbed from the intestine gets routed to the liver to
>get detoxed before it's allowed to go to the heart and then everywhere else.

Drugs that sneak in via mucous membranes, however, *escape* the liver on their way to the heart (at least, on the first go-round.) And the liver really hoses nitroglycerin. In fact, nitroglycerin that has visited the liver is pretty much useless. So if you put your nitro under your tongue, it hits the heart first and the liver second, where it can die AFTER it's done its job. Swallowed nitroglycerin has pretty much no effect.

3. How well does aspirin absorb through your gum?

Not as well as through your gut. It's not terribly soluble. Goodman and Gilman say rectal absorption is not very good for aspirin, and that's with the aspirin smushed up in a suppository TRYING to get it to go through skin. A regular aspirin tablet wouldn't work too well (they're often designed to withstand stomach acid, remember?). So mouth absorption is possible, but not necessarily efficient.

4. Where does aspirin work anyway?

Aspirin does a lot of weird and mysterious things. The one people understand best is that it lowers the level of a group of substances called prostaglandins. Prostaglandins promote pain, inflammation, fever and other icky things, so getting rid of some of them should make you feel better. Prostaglandins are all over your body. Aspirin, as we've seen, is also all over your body, regardless of how it got in there. Your head is part of your body, so you target headache with the precision of a hand grenade (i.e. none). This is why you can take aspirin to make your hand, head, or leg feel better. Aspirin does not do its thing in the brain. Many drugs act there, but aspirin isn't one of them.

So in general, even though only your head may hurt, you can't just give your head aspirin. You can't even really give it a shortcut so it gets there faster. This is unfortunate in the case of cancer chemotherapy, which is viciously poisonous, and which we all wish we could send just to the tumor and not the the person's whole body at the same time.

Aaaaggghh...what a postive note to end on... Anyway, where are the afu docs? Are med students the closest thing afu has to an authority? Scary...

And Ray: "methyl salicyclate...positively sparkling?" Did you by chance ever write Jeopardy questions?

Susie "no way do I know everything, I just have some expensive reference books"

Kretschmer
--

Susie Kretschmer              "Don't ask me, I'm just improvising" 
CWRU School of Medicine                  -Rush, _Presto_

MSTP Class of 1998 Internet: sxk29@po.cwru.edu *VR .sig virus* DS, DNA, and taking names...