Please check your internet connection and try again.
# Aspirin, Enteric-Coated
## Overview
Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) with analgesic, antipyretic, and anti-inflammatory properties. The enteric coating is designed to delay absorption and reduce gastric irritation.
## Primary Indications
* **Cardiovascular prophylaxis:** Secondary prevention of cardiovascular events (e.g., myocardial infarction, stroke) in patients with established cardiovascular disease. Primary prevention in select individuals after risk assessment.
* **Rheumatic fever prophylaxis:** Prevention of recurrent rheumatic fever.
* **Kawasaki disease:** Treatment of Kawasaki disease.
* **Pain and inflammation:** Mild to moderate pain and inflammation (though less commonly used for this indication due to GI risks compared to other NSAIDs).
## Adult Dosing
* **Cardiovascular prophylaxis:** 75-100 mg once daily is typical for secondary prevention. For primary prevention, doses may vary based on risk assessment, but typically range from 75-100 mg once daily. Maximum dose for long-term cardiovascular use is generally not to exceed 325 mg daily.
* **Rheumatic fever prophylaxis:** 100-125 mg once daily.
* **Kawasaki disease:**
* **Acute phase:** 80-100 mg/kg/day divided into 4 doses.
* **Subacute phase (after fever subsides):** 3-5 mg/kg once daily.
* **Pain and inflammation:** Doses vary widely. For mild to moderate pain, 325-650 mg every 4-6 hours as needed. Anti-inflammatory doses are typically higher, ranging from 2400-4000 mg daily divided into multiple doses. **These higher doses are rarely used for routine pain management due to increased risk of adverse effects.**
## Pediatric Dosing
* **Rheumatic fever prophylaxis:** 100-125 mg once daily.
* **Kawasaki disease:**
* **Acute phase:** 80-100 mg/kg/day divided into 4 doses.
* **Subacute phase (after fever subsides):** 3-5 mg/kg once daily.
* **Pain and inflammation:** Dosing varies significantly by indication and age. **Aspirin is generally avoided in children and adolescents with viral illnesses due to the risk of Reye's syndrome.**
## Dose Adjustments
No specific dose adjustments are typically required for renal or hepatic impairment, but caution is advised, and lower doses may be considered due to increased risk of toxicity.
## Contraindications
* Hypersensitivity to aspirin, salicylates, or NSAIDs.
* History of aspirin-induced asthma, urticaria, or allergic-type reactions.
* Active peptic ulcer disease or gastrointestinal bleeding.
* Children and adolescents with viral infections (influenza, chickenpox) due to the risk of Reye's syndrome.
* Bleeding disorders.
* Severe hepatic or renal impairment.
* Third trimester of pregnancy.
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, nausea, vomiting, abdominal pain, heartburn, GI ulceration, bleeding, perforation.
* **Hematologic:** Increased bleeding time, bruising, petechiae, epistaxis, prolonged prothrombin time.
* **Hypersensitivity:** Bronchospasm, angioedema, urticaria, anaphylaxis.
* **Neurologic:** Tinnitus, dizziness, headache, confusion (especially at higher doses).
* **Renal:** Acute kidney injury, interstitial nephritis.
* **Hepatic:** Hepatotoxicity.
* **Reye's Syndrome:** In children and adolescents with viral illnesses.
## 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 bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **SSRIs and SNRIs:** Increased risk of bleeding.
* **Methotrexate:** Aspirin can increase methotrexate toxicity.
* **Uricosuric agents (e.g., probenecid):** Aspirin can decrease the efficacy of uricosuric agents.
* **Antihypertensives:** Aspirin may decrease the effectiveness of some antihypertensives.
* **Alcohol:** Increased risk of GI bleeding.
## Monitoring
* **Signs of GI bleeding:** Melena, hematemesis, abdominal pain.
* **Signs of bleeding:** Easy bruising, prolonged bleeding from cuts, epistaxis.
* **Renal function:** Serum creatinine, BUN, especially in patients with risk factors.
* **Hepatic function:** LFTs, especially in patients with pre-existing liver disease or high-dose therapy.
* **Tinnitus:** May indicate salicylism or overdose.
## Clinical Pearls
* The enteric coating may delay absorption, but it does not eliminate the risk of gastric irritation or bleeding.
* For urgent situations requiring rapid platelet inhibition (e.g., acute coronary syndrome), non-enteric coated aspirin may be preferred due to faster absorption.
* Always assess for contraindications, particularly in pediatric patients with viral illnesses.
* Patients on long-term aspirin therapy should be advised of signs and symptoms of GI bleeding and instructed to report them immediately.
* Consider concurrent use of a proton pump inhibitor (PPI) in patients at high risk for GI events.
***
*Please verify the current prescribing information for the most up-to-date and comprehensive drug details.*
