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# Aspirin (Ecospirin Enteric-Coated)
## Overview
Aspirin is a non-steroidal anti-inflammatory drug (NSAID) with analgesic, antipyretic, and antiplatelet properties. The enteric coating is designed to reduce gastrointestinal irritation.
## Primary Indications
* Pain and inflammation (mild to moderate)
* Fever
* Prevention of cardiovascular events (e.g., myocardial infarction, stroke) in specific patient populations.
## Adult Dosing
**Pain/Fever/Inflammation:**
* 325 mg to 650 mg orally every 4 to 6 hours as needed.
* Maximum daily dose generally 4000 mg. Higher doses may be used for inflammatory conditions under close medical supervision.
**Cardiovascular Prevention:**
* Low-dose aspirin (75 mg to 100 mg) once daily is common. Specific dosing depends on indication and local guidelines.
## Pediatric Dosing
* **Pain/Fever:** 10 mg/kg/dose to 15 mg/kg/dose orally every 4 to 6 hours.
* **Maximum daily dose:** 60 mg/kg/day or 4000 mg/day, whichever is less.
* **Note:** Aspirin should generally be avoided in children and teenagers with viral infections (e.g., influenza, varicella) due to the risk of Reye's syndrome.
## Dose Adjustments
* No specific dose adjustment is typically required for hepatic impairment.
* Use with caution in renal impairment; dose reduction may be considered in severe impairment.
## Contraindications
* Known hypersensitivity to aspirin, salicylates, NSAIDs, or any component of the formulation.
* Children and teenagers with viral infections.
* History of aspirin-induced asthma, urticaria, or other allergic-type reactions.
* Active peptic ulceration or gastrointestinal bleeding.
* Certain bleeding disorders.
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, heartburn, nausea, abdominal pain, occult bleeding, ulceration, perforation.
* **Hematologic:** Increased bleeding risk, bruising.
* **Hypersensitivity:** Bronchospasm, angioedema, urticaria.
* **Other:** Tinnitus (especially with higher doses), dizziness, Reye's syndrome (in children/teenagers with viral infections).
## 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.
* **Methotrexate:** Increased methotrexate toxicity.
* **Antihypertensives (e.g., ACE inhibitors, ARBs, diuretics):** Reduced antihypertensive efficacy, increased risk of renal dysfunction.
* **Valproic acid:** Increased free valproic acid levels.
## Monitoring
* Signs and symptoms of gastrointestinal bleeding (melena, hematemesis, abdominal pain).
* Signs of bleeding or bruising.
* Renal function and electrolytes, especially in patients with pre-existing renal disease or those on long-term therapy.
* Tinnitus or hearing changes, particularly with higher doses.
## Clinical Pearls
* The enteric coating helps protect the stomach lining but does not eliminate the risk of GI side effects, especially with long-term use or higher doses.
* Do not crush or chew enteric-coated tablets; they should be swallowed whole.
* Aspirin's antiplatelet effect is irreversible for the life of the platelet (about 7-10 days).
* Consider the risk of Reye's syndrome when prescribing for pediatric patients.
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*Please verify the current prescribing information for the most up-to-date details on dosing, contraindications, and interactions.*
