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# Aspirin (Enteric-Coated)
## Overview
Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that is also an antiplatelet agent. The enteric coating is designed to delay absorption until the drug reaches the small intestine, potentially reducing gastric irritation.
## Primary Indications
* Primary and secondary prevention of cardiovascular events (e.g., myocardial infarction, stroke) in patients with established cardiovascular disease or at high risk.
* Management of pain and inflammation (less common for enteric-coated formulations due to delayed onset).
* Prevention of pre-eclampsia in select pregnant individuals.
## Adult Dosing
* **Cardiovascular Prevention:** Typical doses range from 75 mg to 325 mg once daily. Lower doses (e.g., 75-100 mg) are often used for long-term secondary prevention. Higher doses (e.g., 325 mg) may be used acutely or when higher antiplatelet effect is desired. The specific dose should be guided by clinical indication and local protocols.
* **Pain/Inflammation:** Doses vary widely depending on the condition being treated, typically ranging from 325 mg to 650 mg every 4-6 hours as needed. Maximum daily dose is generally 4000 mg.
## Pediatric Dosing
Aspirin is generally **not recommended** for use in children and adolescents (under 19 years of age) with viral infections (e.g., influenza, chickenpox) due to the risk of Reye's syndrome. Specific indications and dosing in pediatric populations are uncommon and require expert consultation.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Dose reduction may be considered in severe impairment, though data is limited.
* **Hepatic Impairment:** Use with caution.
* **Elderly:** Increased risk of bleeding; consider lower doses.
## Contraindications
* Hypersensitivity to aspirin, salicylates, or NSAIDs.
* History of asthma, urticaria, or allergic-type reactions induced by aspirin or other NSAIDs.
* Active peptic ulcer disease or gastrointestinal bleeding.
* Bleeding disorders.
* Severe renal or hepatic impairment.
* Third trimester of pregnancy (risk of premature closure of ductus arteriosus).
* Concomitant use with methotrexate at high doses.
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, heartburn, nausea, abdominal pain, GI bleeding, ulceration.
* **Hematologic:** Increased bleeding time, bruising, epistaxis, petechiae.
* **Hypersensitivity:** Bronchospasm, angioedema, urticaria.
* **Other:** Tinnitus (especially at higher doses), dizziness, headache.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, DOACs):** Increased risk of bleeding.
* **Other NSAIDs and COX-2 Inhibitors:** Increased risk of GI toxicity and bleeding.
* **Antihypertensives (e.g., ACE inhibitors, ARBs, diuretics):** May decrease antihypertensive efficacy and increase risk of renal impairment.
* **Antidiabetic Agents:** May increase hypoglycemia risk.
* **Methotrexate:** Increased methotrexate toxicity.
* **Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):** Increased risk of bleeding.
* **Uricosuric Agents:** Decreased efficacy.
## Monitoring
* Signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Signs and symptoms of bleeding or bruising.
* Renal and hepatic function (especially with long-term use or in patients with pre-existing impairment).
* Tinnitus or hearing changes, which may indicate toxicity.
## Clinical Pearls
* The enteric coating can delay the onset of action for pain and inflammation compared to immediate-release aspirin.
* For acute situations requiring rapid antiplatelet effect, immediate-release aspirin is preferred.
* Patients taking aspirin for cardiovascular protection should generally not take other NSAIDs without consulting their healthcare provider due to increased bleeding risk and potential reduction in aspirin's cardioprotective effect.
* If aspirin is needed for pain or inflammation in a patient on low-dose aspirin for cardiovascular protection, consider a different analgesic or separate administration times, and monitor closely for bleeding.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions.*
