Lubomir Leehom

Figure 1. Aspirin-mediated inhibition of cyclooxygenase (COX). COX enzymes exist as dimers. In the absence of aspirin (left panel), arachidonic acid (AA) that is formed by phospholipase A2 breakdown of membrane phospholipids gains access to the active site of COX via a hydrophobic channel. Metabolism of AA by COX produces an intermediate prostaglandin PGH2, which in platelets is broken down by tissue isomerases to thromboxane A2. As shown on the right panel, aspirin irreversibly inhibits COX activity by acetylation of a serine residue in the active site for COX (SER 529 in COX-1 & SER 516 in COX-2). This produces a steric hindrance that prevents AA from being metabolized. Aspirin works by the same mechanism to block COX-2 in other tissues. Adapted from Fitzgerald & FitzGerald (2013).

Figure 2. Selective inhibition of platelet COX-1 activity vs monocyte COX-2 activity measured in vitro after the addition of aspirin to whole-blood samples drawn from healthy human subjects. Bars represent Mean ±SD. Modified from Cipollone et al (1997).

Figure 2. Aspirin's bimodal dose-dependent effect on the renal clearance of urate/uric acid (UA). In patients, low doses of aspirin (75 mg-2 gm/day) cause retention of uric acid by inhibiting uric acid secretion. In contrast, high doses (>3 gm/day) increase the excretion of uric acid in the urine by inhibiting its reuptake in the proximal tubule (Yu & Gutman, 1959). While several clinical studies have confirmed the bimodal effect of aspirin on uric acid clearance, the precise transporters involved have not been clearly identified.

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TESTOSTERONE (tes TOS ter one) is used to increase testosterone levels in your body. It belongs to a group of medications called androgen hormones.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

COMMON BRAND NAME(S): AndroGel, FORTESTA, Testim, Vogelxo

They need to know if you have any of these conditions:

This medication is for external use only. Do not take by mouth. Wash your hands before and after use. Use it as directed on the prescription label, at the same time every day. Do not use it more often than directed. Make sure that you are using your product correctly. Allow the skin to air-dry, then cover with clothing to prevent others from coming in contact with the medication on your skin.

This medication comes with INSTRUCTIONS FOR USE. Ask your pharmacist for directions on how to use this medication. Read the information carefully. Talk to your pharmacist or care team if you have questions.

A special MedGuide will be given to you by the pharmacist with each prescription and refill. Be sure to read this information carefully each time.

Talk to your care team regarding the use of this medication in children. Special care may be needed.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

If you miss a dose, use it as soon as you can. If it is almost time for your next dose, use only that dose. Do not use double or extra doses.

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

Visit your care team for regular checks on your progress. Tell your care team if your symptoms do not start to get better or if they get worse. You may need blood work while you are taking this medication.

Heart attacks and strokes have been reported with the use of this medication. Call emergency services if you develop signs or symptoms of a heart attack or stroke. Talk to your care team about the risks and benefits of this medication.

This medication can transfer from your body to others. If a person or pet comes in contact with the medication, they may have a serious risk of side effects. If you cannot avoid skin-to-skin contact, cover the medication site with clothing. If accidental contact happens, wash the skin of the person or pet right away with soap and water. A partner who is pregnant or trying to get pregnant should avoid contact with the medication and treated skin.

Talk to your care team if you wish to become pregnant or think you might be pregnant. This medication can cause serious birth defects.

This medication may affect blood sugar. Ask your care team if changes in diet or medications are needed if you have diabetes.

This medication is banned from use in athletes by most athletic organizations.

Side effects that you should report to your care team as soon as possible:

Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.