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# Ecospirin (aspirin, enteric-coated) ## Overview Ecospirin contains **acetylsalicylic acid (aspirin)** in an enteric-coated formulation. - **Class:** Antiplatelet; nonsteroidal anti-inflammatory drug (NSAID); analgesic/antipyretic. - **Mechanism:** Irreversibly inhibits platelet cyclooxygenase-1 (COX-1), reducing thromboxane A₂ and platelet aggregation for the platelet’s lifespan (approximately **7–10 days**). - Enteric coating may reduce gastric irritation but **does not eliminate gastrointestinal bleeding risk** and may delay absorption. - Swallow whole with water; **do not crush, chew, or split** enteric-coated tablets unless the product labeling specifically permits it. ## Primary Indications - **Secondary prevention of atherosclerotic cardiovascular disease:** - Prior myocardial infarction (MI) - Ischemic stroke or transient ischemic attack (TIA) - Established peripheral arterial disease - **Acute coronary syndrome (ACS) or suspected acute MI:** aspirin is generally given immediately, preferably as a **chewed immediate-release dose** rather than relying on enteric-coated absorption. - **Post-coronary intervention or coronary artery bypass grafting (CABG):** usually as part of a cardiology-directed regimen. - **Kawasaki disease** in children, under specialist supervision. - **Primary prevention:** not routinely recommended; use only after individualized cardiovascular-versus-bleeding risk assessment. ## Adult Dosing - **Secondary prevention of MI, ischemic stroke/TIA, or peripheral arterial disease:** **75–162 mg orally once daily**; commonly **81 mg once daily**. Some protocols use **75–100 mg once daily**. - **ACS or suspected acute MI:** **160–325 mg immediately**, preferably **chewed immediate-release aspirin**, then **75–100 mg once daily**. Follow emergency and cardiology protocols. - **After PCI/stent or CABG:** Common maintenance dose is **75–100 mg once daily**, often with a P2Y12 inhibitor for a protocol-defined duration. Follow the cardiologist’s regimen. - **Acute ischemic stroke:** Commonly **160–325 mg once after intracranial hemorrhage has been excluded**, followed by **75–100 mg once daily**. Follow local stroke protocols. - **Analgesic/antipyretic or anti-inflammatory use:** **325–650 mg every 4–6 hours** or **650–1,000 mg every 6–8 hours**. **Maximum: 4,000 mg/day**, although lower limits (for example, **3,000 mg/day**) are often preferred in older adults or patients with increased toxicity risk. Low-dose enteric-coated products are not ideal for acute pain. - **Preeclampsia prevention in selected high-risk pregnancies:** **81 mg once daily**, typically starting at **12–28 weeks’ gestation**, preferably before 16 weeks, until delivery—only when prescribed by the obstetric clinician. ## Pediatric Dosing Routine aspirin use in children is generally avoided because of the risk of **Reye syndrome**. - **Kawasaki disease—specialist-directed dosing:** - Acute phase: **30–50 mg/kg/day orally divided every 6–8 hours**; some protocols use **80–100 mg/kg/day**. - After fever resolves: **3–5 mg/kg once daily** for antiplatelet therapy, commonly continued for **6–8 weeks** or longer if coronary abnormalities persist. - **Other pediatric antiplatelet indications:** typically **1–5 mg/kg once daily** under pediatric cardiology/hematology supervision; protocols vary. - **Do not give aspirin to children or adolescents with viral illness or suspected viral illness** (especially influenza or varicella) unless specifically directed by a specialist. - Dosing must use the child’s **current weight** and the exact product strength. ## Dose Adjustments - **Renal impairment:** No universally established adjustment for low-dose antiplatelet therapy. Use cautiously; avoid or seek specialist advice in **severe renal impairment**, dehydration, or active kidney injury. Monitor renal function. - **Hepatic impairment:** Use cautiously; avoid in **severe hepatic disease** or active bleeding risk. Monitor clinically and consider liver function testing. - **Older adults, low body weight, prior ulcer/bleeding, or concomitant anticoagulants:** No routine dose adjustment, but use the **lowest effective dose** and reassess bleeding risk. - **Before surgery or invasive procedures:** Do not stop aspirin used for secondary prevention or coronary stents without prescriber/cardiology advice. Elective discontinuation, when appropriate, is commonly **5–7 days before surgery**, but is procedure- and indication-specific. - **Gout:** Aspirin can alter uric acid handling and may worsen gout, especially at low doses. ## Contraindications - Hypersensitivity to aspirin, salicylates, or NSAIDs - Aspirin/NSAID-induced asthma, urticaria, or anaphylaxis - **Active gastrointestinal bleeding** or active peptic ulcer disease - Significant bleeding disorder or severe thrombocytopenia - Severe hepatic or renal impairment, unless specialist-directed - Concurrent use with **methotrexate ≥15 mg/week** in many product labels - Children or adolescents with viral infection, except specialist-directed indications such as Kawasaki disease - **Third-trimester pregnancy** at analgesic/anti-inflammatory doses; low-dose obstetric use may be appropriate only when prescribed ## Adverse Effects - Dyspepsia, nausea, abdominal pain - Gastritis, peptic ulceration, gastrointestinal bleeding - Easy bruising, epistaxis, prolonged bleeding time - Hypersensitivity, bronchospasm, angioedema, anaphylaxis - Renal injury, fluid retention, hypertension - Tinnitus, hearing changes, dizziness—possible salicylate toxicity - Hemolysis in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency, particularly at higher doses - Severe toxicity: vomiting, hyperventilation, confusion, metabolic disturbances, seizures, or coma **Seek urgent care for:** black/tarry stools, vomiting blood, severe allergic symptoms, sudden severe headache, neurologic deficits, or suspected overdose. ## Key Drug Interactions - **Anticoagulants** (warfarin, apixaban, rivaroxaban, dabigatran, heparins): substantially increased bleeding risk. - **Other antiplatelets** (clopidogrel, prasugrel, ticagrelor): additive bleeding risk; often intentional after ACS/PCI but must be prescribed. - **NSAIDs**, including ibuprofen and naproxen: increased gastrointestinal/renal toxicity. Ibuprofen may interfere with aspirin’s antiplatelet effect if taken around the same time. - **Methotrexate:** increased methotrexate toxicity; avoid or obtain specialist guidance, particularly at doses **≥15 mg/week**. - **Systemic corticosteroids, SSRIs/SNRIs, alcohol:** increased gastrointestinal bleeding risk. - **ACE inhibitors, ARBs, diuretics, and nephrotoxic drugs:** increased risk of renal impairment, especially with dehydration or chronic kidney disease. - **Valproate, lithium, phenytoin, and sulfonylureas:** aspirin may increase drug exposure or toxicity; monitor as appropriate. - **Probenecid:** reduced urate-lowering effect. - **Aluminum/magnesium antacids:** may alter absorption; separate if clinically necessary and follow product guidance. ## Monitoring - Confirm indication, dose, adherence, and ongoing cardiovascular benefit. - Assess for bruising, melena, hematemesis, hematuria, anemia, or other bleeding. - Check **CBC/hemoglobin and platelets** periodically when long-term therapy or bleeding risk is present. - Monitor **serum creatinine/eGFR** in older adults, renal disease, dehydration, or interacting therapy. - Consider liver function tests in hepatic disease or prolonged high-dose use. - Monitor blood pressure and gastrointestinal symptoms. - Monitor for tinnitus, hyperventilation, confusion, or other salicylate toxicity with high doses. - For patients on warfarin, monitor **INR** closely after starting, stopping, or changing aspirin. - Test for **H. pylori** or consider gastroprotection, such as a proton-pump inhibitor, when gastrointestinal risk is high. ## Clinical Pearls - For chronic antiplatelet therapy, the usual dose is **81 mg once daily**; higher doses generally increase bleeding without improving antiplatelet benefit. - Enteric-coated aspirin is **not preferred for emergency ACS treatment** because absorption may be delayed; use chewable immediate-release aspirin when available. - Do not routinely combine aspirin with ibuprofen. If unavoidable, prescriber/pharmacist-directed timing is required; ibuprofen taken before aspirin may reduce aspirin’s cardioprotective effect. - Do not discontinue aspirin abruptly after coronary stent placement or for secondary prevention without medical advice. - Aspirin lowers platelet function for **7–10 days**; bleeding risk may persist after the last dose. - Low-dose aspirin for pregnancy prevention is distinct from high-dose aspirin for pain or inflammation. - Aspirin is not routinely indicated for primary prevention in older adults or people at increased bleeding risk. - In suspected overdose, contact emergency services or a poison center immediately; do not wait for symptoms. *Educational information only. Verify the current product labeling, local guidelines, contraindications, and patient-specific prescribing instructions before use.*