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# Aspirin (Enteric-Coated)
## Overview
Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) with analgesic, anti-inflammatory, and antipyretic properties. The enteric coating is designed to delay absorption and reduce gastrointestinal upset.
## Primary Indications
* Pain and inflammation
* Fever reduction
* Cardiovascular event prophylaxis (e.g., myocardial infarction, stroke)
## Adult Dosing
* **Pain/Inflammation/Fever:** 325 mg to 650 mg every 4 to 6 hours as needed. Maximum dose: 4 g daily.
* **Cardiovascular Prophylaxis:**
* Primary prevention: 81 mg to 162 mg once daily.
* Secondary prevention: 81 mg to 325 mg once daily. Dosing may vary based on specific cardiovascular event and local guidelines.
## Pediatric Dosing
Aspirin is generally **contraindicated in children and adolescents** due to the risk of Reye's syndrome, especially during viral illnesses like influenza or chickenpox. If aspirin is deemed absolutely necessary, consult specialized pediatric resources and consider risks carefully.
## Dose Adjustments
No specific dose adjustments are typically required for hepatic or renal impairment, but caution is advised.
## Contraindications
* Hypersensitivity to aspirin, NSAIDs, or salicylates.
* Active peptic ulceration or history of gastrointestinal bleeding.
* Children and adolescents with viral infections.
* Patients with asthma, urticaria, or allergic-type reactions after taking NSAIDs or salicylates.
* Hemophilia or other bleeding disorders.
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, nausea, vomiting, abdominal pain, GI bleeding, ulceration.
* **Hematologic:** Increased bleeding tendency, thrombocytopenia.
* **Hypersensitivity:** Bronchospasm, urticaria, angioedema.
* **Other:** Tinnitus, dizziness, headache.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, heparin, DOACs):** Increased risk of bleeding.
* **Other NSAIDs:** Increased risk of GI toxicity and bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Methotrexate:** Increased risk of methotrexate toxicity.
* **Alcohol:** Increased risk of GI bleeding.
* **Uricosuric agents (e.g., probenecid):** Decreased efficacy of uricosuric agents.
## Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis, abdominal pain).
* Monitor for signs of bleeding or bruising, especially when used with anticoagulants.
* Monitor for tinnitus or hearing loss, which may indicate toxicity.
## Clinical Pearls
* Enteric-coated formulations are intended to bypass the stomach and dissolve in the small intestine, reducing gastric irritation. However, they may have slower absorption than non-coated formulations.
* Aspirin should be taken with a full glass of water.
* Avoid concomitant use with other NSAIDs unless specifically indicated and monitored.
* For cardiovascular prophylaxis, adherence to a low-dose regimen is crucial.
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*Please verify the current prescribing information and consult with a healthcare professional for specific patient management decisions.*
