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## Ecospirin (Aspirin, Enteric-Coated)
### Overview
Ecospirin is an enteric-coated formulation of aspirin, a non-steroidal anti-inflammatory drug (NSAID) that inhibits platelet aggregation. The enteric coating is designed to prevent dissolution in the stomach, reducing gastric irritation.
### Primary Indications
* Secondary prevention of cardiovascular events (e.g., myocardial infarction, stroke) in patients with established cardiovascular disease.
* Primary prevention of cardiovascular events in select high-risk patients (controversial and individualized).
* Antiplatelet therapy in specific situations, such as after coronary artery stent placement.
### Adult Dosing
* **Cardiovascular Prevention:** Typically 75 mg to 162 mg once daily. Dosing for primary prevention is highly individualized based on risk assessment and should be determined by a healthcare provider.
* **Post-Coronary Stenting:** Often initiated at a higher dose (e.g., 162 mg to 325 mg) followed by a maintenance dose of 75 mg to 162 mg daily, as per cardiology guidelines.
### Pediatric Dosing
Aspirin is generally **not recommended** for children and adolescents due to the risk of Reye's syndrome, a rare but serious condition, especially during viral infections (e.g., influenza, varicella).
### Dose Adjustments
* **Renal Impairment:** Use with caution. Dose reduction may be necessary in severe renal impairment.
* **Hepatic Impairment:** Use with caution. Monitor liver function.
### Contraindications
* Hypersensitivity to aspirin, NSAIDs, or salicylates.
* Active peptic ulcer disease or history of recurrent gastrointestinal bleeding.
* Asthma with aspirin sensitivity.
* Severe renal or hepatic impairment.
* Bleeding disorders.
* Concurrent use of high-dose methotrexate.
* Children and adolescents with viral illnesses (risk of Reye's syndrome).
### Adverse Effects
* **Gastrointestinal:** Dyspepsia, heartburn, nausea, vomiting, abdominal pain, occult bleeding, peptic ulceration, perforation.
* **Bleeding:** Increased risk of bleeding (gastrointestinal, intracranial, or elsewhere).
* **Hypersensitivity:** Bronchospasm, urticaria, angioedema.
* **Other:** Tinnitus, hearing loss (especially at higher doses), dizziness.
### Key Drug Interactions
* **Anticoagulants (e.g., warfarin, heparin, DOACs):** Increased risk of bleeding.
* **Other NSAIDs and COX-2 Inhibitors:** Increased risk of gastrointestinal bleeding and renal toxicity.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **Selective Serotonin Reuptake Inhibitors (SSRIs):** May increase bleeding risk.
* **Methotrexate:** Increased methotrexate toxicity.
* **Antihypertensives (e.g., ACE inhibitors, ARBs, diuretics, beta-blockers):** NSAIDs can reduce antihypertensive efficacy and increase risk of renal impairment.
* **Uricosuric agents (e.g., probenecid):** Aspirin can decrease their efficacy.
### Monitoring
* Signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis, abdominal pain).
* Signs of bleeding elsewhere (e.g., bruising, petechiae, epistaxis).
* Renal and hepatic function (periodically, especially in patients with risk factors).
* Tinnitus or hearing changes, particularly with higher doses.
### Clinical Pearls
* The enteric coating reduces but does not eliminate the risk of gastrointestinal irritation or bleeding.
* Concomitant use of proton pump inhibitors (PPIs) or misoprostol may be considered for patients at high risk of gastrointestinal events.
* Discontinue aspirin at least 5-7 days prior to elective surgery, weighing the risks of bleeding against the risk of thrombotic events.
* Toxicity can occur with overdose or prolonged use at high doses, manifesting as salicylism (tinnitus, nausea, vomiting, dizziness).
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*Disclaimer: This information is for educational purposes only and does not substitute professional medical advice. Always consult the current prescribing information and a qualified healthcare provider for any medical decisions or before making any changes to your medication regimen.*
