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# Aspirin (Ecospirin Enteric-Coated)
## Overview
Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) with analgesic, antipyretic, and anti-inflammatory properties. It also has antiplatelet effects through irreversible inhibition of cyclooxygenase (COX)-1. The enteric coating is designed to delay absorption and reduce gastric irritation.
## Primary Indications
* **Pain and Fever:** Mild to moderate pain and fever.
* **Inflammatory Conditions:** Rheumatoid arthritis, osteoarthritis, other inflammatory conditions (less common for enteric-coated formulations used for these indications).
* **Cardiovascular Prevention:** Secondary prevention of myocardial infarction and stroke; primary prevention in select high-risk individuals.
## Adult Dosing
* **Pain/Fever:** 325 mg to 650 mg orally every 4 to 6 hours as needed. Maximum: 4000 mg per day.
* **Cardiovascular Prevention (Secondary):** 75 mg to 162 mg once daily. Doses higher than 162 mg are generally not recommended for chronic daily use for secondary prevention.
* **Cardiovascular Prevention (Primary):** 81 mg to 100 mg once daily (in select patients aged 40-70 years with elevated cardiovascular risk and low bleeding risk, as determined by clinical guidelines).
## Pediatric Dosing
Aspirin is generally **contraindicated** in children and adolescents with viral infections (e.g., influenza, varicella) due to the risk of Reye's syndrome. For other indications, dosing should be based on strict clinical protocol and physician guidance. There is no standard pediatric dosing for routine pain/fever due to the Reye's syndrome risk.
## Dose Adjustments
No dose adjustment is generally needed for renal or hepatic impairment, but caution is advised, especially with higher doses or prolonged use, due to potential for toxicity.
## Contraindications
* Hypersensitivity to aspirin, salicylates, NSAIDs, or any component of the formulation.
* Children and adolescents with viral infections.
* Active peptic ulceration or gastrointestinal bleeding.
* History of aspirin-induced asthma or bronchospasm.
* Severe hepatic impairment.
* Severe renal impairment.
* Coagulation disorders.
* Last trimester of pregnancy.
## Adverse Effects
* **Common:** Dyspepsia, heartburn, nausea, abdominal pain.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; tinnitus, hearing loss (especially with higher doses); bronchospasm, allergic reactions; Reye's syndrome (in children/adolescents with viral illness); renal impairment.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, heparin, DOACs):** Increased risk of bleeding.
* **Other NSAIDs and COX-2 Inhibitors:** Increased risk of gastrointestinal toxicity and potential for additive antiplatelet effects.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **Selective Serotonin Reuptake Inhibitors (SSRIs):** Increased risk of bleeding.
* **Methotrexate:** Aspirin can increase methotrexate levels, leading to toxicity.
* **Uricosuric agents (e.g., probenecid):** Aspirin can decrease the efficacy of uricosuric agents.
* **Valproic acid:** Aspirin can displace valproic acid from protein-binding sites, increasing free valproic acid levels.
## Monitoring
* **Gastrointestinal symptoms:** Monitor for signs of bleeding (melena, hematemesis) or ulceration.
* **Renal function:** Monitor in patients with pre-existing renal disease or at risk.
* **Liver function:** Monitor if liver dysfunction is suspected.
* **Signs of hypersensitivity:** Monitor for rash, wheezing.
* **Tinnitus:** Can be an early sign of salicylate toxicity.
## Clinical Pearls
* The enteric coating reduces gastric irritation but delays absorption, meaning it is not suitable for rapid pain relief.
* Aspirin should be taken with food or milk to minimize gastric upset.
* Patients should avoid concurrent use of other NSAIDs unless specifically advised by a healthcare professional.
* Discontinue aspirin at least 5-7 days before elective surgery.
* For cardiovascular indications, adherence to the prescribed daily dose is crucial.
This information is intended for healthcare professionals and should not replace consultation with current prescribing information and clinical guidelines. Always verify current drug information before making clinical decisions.
