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# Aspirin (Enteric-Coated)
## Overview
Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) with analgesic, antipyretic, and antiplatelet properties. The enteric coating is designed to delay absorption and reduce gastrointestinal irritation.
## Primary Indications
* Cardiovascular risk reduction (secondary prevention of myocardial infarction and stroke)
* Primary prevention of cardiovascular disease (in select high-risk individuals)
* Rheumatic fever prophylaxis
## Adult Dosing
* **Cardiovascular risk reduction:** 75-162 mg orally once daily.
* **Primary prevention:** 75-100 mg orally once daily. The decision to initiate primary prevention should be individualized based on cardiovascular risk assessment and bleeding risk.
* **Rheumatic fever prophylaxis:** 75-100 mg orally once daily.
## Pediatric Dosing
Aspirin is generally **not recommended** for children and adolescents under 19 years of age for fever or pain due to the risk of Reye's syndrome. Specific indications like rheumatic fever prophylaxis may have different dosing guidelines under specialist care.
## Dose Adjustments
* **Renal Impairment:** Use with caution in severe renal impairment; dose reduction may be considered.
* **Hepatic Impairment:** Use with caution in hepatic impairment.
## Contraindications
* Hypersensitivity to aspirin, salicylates, NSAIDs, or any component of the formulation.
* Asthma, urticaria, or other allergic-type reactions after taking aspirin or other NSAIDs.
* Active peptic ulceration or gastrointestinal bleeding.
* Children and adolescents with viral infections (e.g., influenza, varicella) due to the risk of Reye's syndrome.
* Third trimester of pregnancy.
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, nausea, vomiting, heartburn, abdominal pain, GI bleeding, ulceration.
* **Hematologic:** Increased bleeding time, bruising, epistaxis, occult blood loss.
* **Hypersensitivity:** Bronchospasm, urticaria, angioedema.
* **Other:** Tinnitus (especially with higher doses), dizziness, headache.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, heparin, DOACs):** Increased risk of bleeding.
* **Other NSAIDs and Salicylates:** Increased risk of GI toxicity and bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Antihypertensives:** May decrease the efficacy of some antihypertensives.
* **Methotrexate:** May increase methotrexate toxicity.
* **Alcohol:** Increased risk of GI bleeding.
## Monitoring
* Signs and symptoms of GI bleeding (e.g., melena, hematemesis, abdominal pain).
* Signs and symptoms of bleeding or bruising.
* Renal function, especially in patients with pre-existing renal disease.
## Clinical Pearls
* The enteric coating of Ecospirin may delay absorption; do not crush or chew enteric-coated tablets.
* For acute cardiovascular events (e.g., suspected MI), immediate-release aspirin is preferred for faster absorption.
* Patients should be advised to report any signs of bleeding or black, tarry stools immediately.
* The risk of Reye's syndrome with aspirin use in children and adolescents with viral illnesses is a critical safety concern.
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*Please verify this information with the most current prescribing information or a trusted drug reference.*
