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# Aspirin, Enteric-Coated (Ecospirin)
## Overview
Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) with analgesic, anti-inflammatory, and antipyretic properties. The enteric coating is designed to delay absorption and reduce gastrointestinal irritation.
## Primary Indications
* **Cardiovascular Prevention:** Secondary prevention of myocardial infarction, stroke, and cardiovascular death in patients with established cardiovascular disease. Primary prevention in select high-risk individuals.
* **Pain and Inflammation:** Mild to moderate pain and inflammatory conditions (though less common for enteric-coated formulations due to slower onset).
* **Kawasaki Disease:** Treatment and prevention of coronary artery aneurysms.
## Adult Dosing
* **Cardiovascular Prevention:**
* **Secondary Prevention:** 75-100 mg once daily.
* **Primary Prevention:** 75-100 mg once daily (risk/benefit assessment required).
* **Post-MI/ACS/PCI:** Loading dose often higher (e.g., 162-325 mg), followed by maintenance of 75-100 mg daily. Specific protocols vary.
* **Pain/Inflammation:** Doses typically range from 325 mg to 650 mg every 4-6 hours as needed. Maximum daily dose is generally 4000 mg, but lower doses are preferred for chronic use and cardiovascular protection.
* **Kawasaki Disease:**
* **Acute Phase:** 80-100 mg/kg/day divided into 4 doses.
* **Convalescent Phase:** 3-5 mg/kg once daily.
## Pediatric Dosing
* **Kawasaki Disease:** As above (80-100 mg/kg/day for acute phase, 3-5 mg/kg/day for convalescent phase).
* **Pain/Inflammation:** Use is generally discouraged due to the risk of Reye's syndrome, especially during viral illnesses. If used, doses are typically calculated based on weight, but specific pediatric guidelines should be consulted and used with extreme caution.
## Dose Adjustments
* No specific dose adjustment is typically required for hepatic or renal impairment unless severe. However, caution is advised in these populations due to potential risks.
## Contraindications
* Hypersensitivity to aspirin or other NSAIDs.
* History of aspirin-induced asthma, urticaria, or other allergic-type reactions.
* Active peptic ulcer disease or gastrointestinal bleeding.
* Children and teenagers with viral infections (influenza or chickenpox) due to risk of Reye's syndrome.
* Severe hepatic or renal impairment.
* Severe heart failure.
* Late pregnancy (third trimester).
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, nausea, vomiting, abdominal pain, bleeding, ulceration.
* **Hematologic:** Increased bleeding tendency, bruising, prolonged bleeding time, thrombocytopenia.
* **Respiratory:** Bronchospasm, asthma exacerbation (especially in aspirin-sensitive asthmatics).
* **Other:** Tinnitus, hearing loss (especially at higher doses), dizziness, headache, rash, anaphylaxis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, heparin, DOACs):** Increased risk of bleeding.
* **Other NSAIDs and COX-2 Inhibitors:** Increased risk of GI toxicity and potentially reduced cardioprotective effect of aspirin.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Antihypertensives (e.g., ACE inhibitors, ARBs, diuretics):** May reduce antihypertensive efficacy and increase risk of renal impairment.
* **Methotrexate:** Aspirin can increase methotrexate toxicity.
* **Valproic acid:** Aspirin can displace valproic acid from protein binding sites, increasing free valproic acid levels.
* **Uricosuric agents (e.g., probenecid):** Aspirin can decrease the efficacy of uricosuric agents.
## Monitoring
* **Bleeding:** Signs and symptoms of occult or overt bleeding (hematemesis, melena, bruising, epistaxis).
* **GI Upset:** Dyspepsia, abdominal pain.
* **Renal Function:** Especially in patients with pre-existing renal disease or those on concomitant nephrotoxic agents.
* **Hepatic Function:** Particularly with long-term or high-dose use.
* **Tinnitus/Hearing:** May indicate toxicity.
## Clinical Pearls
* Enteric-coated aspirin should not be crushed or chewed to preserve the coating and minimize gastric irritation.
* For acute situations requiring rapid platelet inhibition (e.g., acute coronary syndrome), non-enteric coated aspirin is preferred due to faster absorption.
* The cardioprotective dose (75-100 mg) is significantly lower than doses used for pain or inflammation.
* Consider proton pump inhibitors (PPIs) for patients at high risk of GI bleeding when aspirin is indicated.
* Patient education regarding signs of bleeding and the importance of not crushing the enteric-coated formulation is crucial.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines for definitive guidance. Local protocols may vary.*
