Please check your internet connection and try again.
## Ecospirin (Aspirin Enteric-Coated)
### Overview
Ecospirin is an enteric-coated formulation of aspirin, a nonsteroidal anti-inflammatory drug (NSAID) that inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis. The enteric coating is designed to prevent dissolution in the stomach and release in the small intestine, potentially reducing gastric irritation.
### Primary Indications
* **Pain and Inflammation:** Relief of mild to moderate pain and inflammation.
* **Fever:** Reduction of fever.
* **Cardiovascular Prophylaxis:** Prevention of myocardial infarction, stroke, and cardiovascular death in patients with a history of these events or at high risk.
* **Kawasaki Disease:** Treatment of acute Kawasaki disease (adjunctive therapy).
### Adult Dosing
* **Pain/Inflammation/Fever:**
* 325 mg to 650 mg orally every 4 to 6 hours as needed.
* Maximum dose: Typically 4000 mg per day, but lower limits may apply for chronic use.
* **Cardiovascular Prophylaxis:**
* Low-dose aspirin: 75 mg to 100 mg orally once daily. Some guidelines suggest up to 325 mg once daily for initial management post-ACS or PCI.
* **Kawasaki Disease:**
* Acute phase: 80 to 100 mg/kg/day orally divided into 4 doses.
* Subacute phase (after fever resolves): 3 to 5 mg/kg/day orally once daily.
### Pediatric Dosing
* **Pain/Inflammation/Fever:**
* 10 mg/kg/dose to 15 mg/kg/dose orally every 4 to 6 hours.
* Maximum dose: 4000 mg per day.
* **Note:** Aspirin should be used with caution in children and adolescents due to the risk of Reye's syndrome, especially during viral illnesses.
* **Kawasaki Disease:** Dosing as listed in adult section.
### Dose Adjustments
* No specific dose adjustments are typically required for renal or hepatic impairment, but caution is advised. High doses or prolonged use in severe renal impairment may increase the risk of toxicity.
### Contraindications
* Known hypersensitivity to aspirin, salicylates, or NSAIDs.
* History of bronchospasm, asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Active peptic ulceration or gastrointestinal bleeding.
* Children and adolescents with viral infections (e.g., influenza, chickenpox) due to the risk of Reye's syndrome.
* Bleeding disorders.
* Severe hepatic or renal impairment.
### Adverse Effects
* **Gastrointestinal:** Dyspepsia, heartburn, nausea, vomiting, abdominal pain, gastritis, peptic ulceration, GI bleeding.
* **Hematologic:** Increased bleeding time, bruising, epistaxis, petechiae.
* **Hypersensitivity:** Urticaria, rash, angioedema, bronchospasm, anaphylaxis.
* **Renal:** Renal insufficiency, interstitial nephritis.
* **Hepatic:** Hepatotoxicity (rare).
* **Other:** Tinnitus, hearing loss (especially with higher doses), dizziness.
* **Reye's Syndrome:** In children/adolescents with viral illnesses.
### Key Drug Interactions
* **Anticoagulants (e.g., warfarin, heparin, DOACs):** Increased risk of bleeding.
* **Other NSAIDs (including COX-2 inhibitors):** Increased risk of GI bleeding and ulceration. May also affect aspirin's cardioprotective effect.
* **Corticosteroids:** Increased risk of GI bleeding and ulceration.
* **Antihypertensives (e.g., ACE inhibitors, ARBs, diuretics, beta-blockers):** Aspirin may decrease their efficacy. Increased risk of renal dysfunction.
* **Uricosuric agents (e.g., probenecid):** Aspirin can decrease the efficacy of uricosuric agents.
* **Methotrexate:** Aspirin can increase methotrexate levels and toxicity.
* **Selective Serotonin Reuptake Inhibitors (SSRIs):** Increased risk of bleeding.
* **Valproic Acid:** Aspirin can displace valproic acid from plasma protein binding sites, increasing free valproic acid concentrations.
### Monitoring
* **Bleeding:** Monitor for signs of occult or overt GI bleeding (melena, hematemesis), easy bruising, prolonged bleeding from cuts.
* **Renal Function:** Periodic assessment of renal function may be necessary, especially with long-term use or in patients with pre-existing renal disease.
* **Hepatic Function:** Periodic assessment may be necessary, particularly with long-term use or in patients with liver disease.
* **Tinnitus/Hearing:** Assess for tinnitus or hearing changes, which can indicate salicylate toxicity.
### Clinical Pearls
* The enteric coating slows absorption and may reduce gastric irritation but does not eliminate the risk of GI bleeding. Do not crush or chew enteric-coated tablets.
* Aspirin's antiplatelet effect is irreversible and lasts for the life of the platelet (7-10 days).
* For cardiovascular prophylaxis, consistent daily dosing is crucial.
* When used for pain/fever, higher doses are used compared to cardiovascular prophylaxis.
* Patients taking aspirin for cardiovascular indications should generally avoid other NSAIDs unless specifically advised by a healthcare provider.
* Discontinue aspirin at least 5-7 days before elective surgery.
**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols before initiating or modifying therapy.
