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# Ecospirin Enteric-Coated
## Overview
Ecospirin Enteric-Coated is a brand name for aspirin, a nonsteroidal anti-inflammatory drug (NSAID) with analgesic, antipyretic, and antiplatelet properties. The enteric coating is designed to delay absorption until the drug reaches the small intestine, which may reduce gastric irritation.
## Primary Indications
* **Pain and Fever:** Mild to moderate pain and fever.
* **Inflammation:** Inflammatory conditions such as arthritis.
* **Cardiovascular Prevention:** Secondary prevention of cardiovascular events (e.g., myocardial infarction, stroke) in patients with established cardiovascular disease. Primary prevention is controversial and decision-making is individualized.
## Adult Dosing
Dosing varies significantly by indication.
* **Pain/Fever:** 325 mg to 650 mg orally every 4-6 hours as needed. Maximum daily dose typically 4000 mg.
* **Inflammation:** 2.6 g to 5.4 g per day in divided doses.
* **Cardiovascular Prevention (Secondary):** 75 mg to 162 mg once daily.
* **Cardiovascular Prevention (Primary):** Decisions are individualized based on risk assessment. Doses of 75 mg to 162 mg once daily are often considered, but risk of bleeding must be weighed against benefit.
## Pediatric Dosing
* **Pain/Fever:** 10 mg/kg/dose to 15 mg/kg/dose orally every 4-6 hours. Maximum daily dose typically 75 mg/kg/day (up to 4000 mg/day).
* **Kawasaki Disease:** Dosing is higher and phased, often starting with 80-100 mg/kg/day divided into 4 doses, then transitioning to 3-5 mg/kg/day once daily. Specific protocols should be followed.
* **Reye's Syndrome:** Aspirin is CONTRAINDICATED in children and adolescents with viral infections due to the risk of Reye's syndrome.
## Dose Adjustments
No specific dose adjustments are typically required for hepatic or renal impairment, but caution is advised, especially in severe impairment, due to potential for adverse effects. Monitor closely.
## Contraindications
* Known hypersensitivity to aspirin, salicylates, NSAIDs, or tartrazine.
* Children and adolescents with viral infections (e.g., influenza, chickenpox) due to risk of Reye's syndrome.
* Bronchospasm, urticaria, or allergic rhinitis precipitated by aspirin or other NSAIDs.
* Active peptic ulceration or gastrointestinal bleeding.
* Severe hepatic impairment.
* Severe renal impairment.
* Severe heart failure.
* Third trimester of pregnancy.
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, nausea, vomiting, abdominal pain, GI bleeding, ulceration.
* **Hematologic:** Increased bleeding time, bruising, petechiae, epistaxis, prolonged prothrombin time.
* **Ototoxicity:** Tinnitus, hearing loss (often reversible with dose reduction).
* **Respiratory:** Bronchospasm (especially in asthmatics).
* **Other:** Rash, urticaria, dizziness.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, heparin, DOACs):** Increased risk of bleeding.
* **Other NSAIDs and COX-2 Inhibitors:** Increased risk of GI toxicity, bleeding, and renal impairment.
* **Antihypertensives (e.g., ACE inhibitors, ARBs, diuretics):** Reduced antihypertensive effect; increased risk of renal impairment.
* **Methotrexate:** Increased methotrexate toxicity.
* **Selective Serotonin Reuptake Inhibitors (SSRIs):** Increased risk of bleeding.
* **Valproic Acid:** Can displace valproate from protein-binding sites, increasing levels.
## Monitoring
* **GI Symptoms:** Monitor for signs of GI bleeding (e.g., melena, hematemesis).
* **Bleeding:** Monitor for increased bruising, prolonged bleeding from cuts, petechiae.
* **Renal Function:** Monitor BUN and creatinine, especially in patients with risk factors for renal impairment.
* **Hepatic Function:** Monitor LFTs, especially in patients with hepatic disease.
* **Tinnitus/Hearing:** Assess for tinnitus and hearing changes, which can indicate salicylism.
## Clinical Pearls
* The enteric coating reduces gastric irritation but does not eliminate the risk of GI bleeding.
* Aspirin should be taken with food or milk to minimize gastric upset.
* Do not crush or chew enteric-coated aspirin, as this will destroy the coating and increase gastric irritation.
* Discontinue aspirin at least 5-7 days prior to elective surgery.
* In patients with established cardiovascular disease, the benefit of low-dose aspirin in preventing cardiovascular events generally outweighs the bleeding risk.
* In primary prevention, the decision to use aspirin should be individualized after a thorough risk-benefit assessment, considering age, risk factors for cardiovascular disease, and bleeding risk.
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*This information is intended for healthcare professionals. Always consult the official prescribing information and relevant clinical guidelines for the most current and comprehensive details before making any clinical decisions.*
