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## Ecospirin (Aspirin) Enteric-Coated
**Overview**
Ecospirin is an enteric-coated formulation of aspirin, a nonsteroidal anti-inflammatory drug (NSAID) with analgesic, anti-inflammatory, and antipyretic properties. The enteric coating is designed to prevent gastric irritation by delaying dissolution until the small intestine.
**Primary Indications**
* Pain relief (mild to moderate)
* Fever reduction
* Inflammation reduction
* Prevention of cardiovascular events (e.g., myocardial infarction, stroke) in patients at risk (low-dose aspirin)
**Adult Dosing**
* **Analgesia/Antipyresis:** 325 mg to 650 mg every 4 to 6 hours as needed. Maximum dose is typically 4000 mg per 24 hours.
* **Anti-inflammatory:** 2.6 g to 5.4 g per day, divided into 3 or 4 doses.
* **Cardiovascular Prevention:** 75 mg to 325 mg once daily. Specific dose and indication depend on patient risk factors and physician guidance.
**Pediatric Dosing**
* **Pain/Fever:** Dosing is typically weight-based, generally 10 mg/kg to 15 mg/kg per dose every 4 to 6 hours. The maximum single dose should not exceed 650 mg.
* **Kawasaki Disease:** Dosing varies significantly depending on the phase of illness and physician protocol. High-dose (80-100 mg/kg/day divided every 6 hours) during the acute febrile phase, followed by low-dose (3-5 mg/kg/day once daily) for extended periods.
* **Reye's Syndrome Warning:** Aspirin should **not** be used in children or adolescents with viral infections (e.g., influenza, varicella) due to the risk of Reye's syndrome.
**Dose Adjustments**
* **Hepatic Impairment:** Use with caution; dose adjustment may be needed.
* **Renal Impairment:** Use with caution; dose adjustment may be needed, especially in severe impairment.
**Contraindications**
* Hypersensitivity to aspirin, NSAIDs, or salicylates.
* Active peptic ulceration or gastrointestinal bleeding.
* Children and adolescents with viral infections (risk of Reye's syndrome).
* Severe hepatic or renal impairment.
* Severe heart failure.
* Use in the third trimester of pregnancy.
**Adverse Effects**
* **Common:** Dyspepsia, heartburn, nausea, vomiting, abdominal pain.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation, tinnitus, hearing loss, bronchospasm (especially in aspirin-sensitive asthma), renal dysfunction, hypersensitivity reactions, Reye's syndrome (in children/adolescents with viral illness).
**Key Drug Interactions**
* **Anticoagulants (e.g., warfarin, heparin):** Increased risk of bleeding.
* **Other NSAIDs and COX-2 Inhibitors:** Increased risk of gastrointestinal bleeding and reduced cardioprotective effect of low-dose aspirin.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **Methotrexate:** Increased methotrexate toxicity.
* **Antihypertensives (e.g., ACE inhibitors, diuretics):** May decrease their efficacy.
* **Uricosuric agents:** Decreased efficacy.
* **Selective Serotonin Reuptake Inhibitors (SSRIs):** Increased risk of bleeding.
**Monitoring**
* Signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Tinnitus or hearing changes, which may indicate toxicity.
* Renal and hepatic function, especially with long-term use or in patients with pre-existing impairment.
* Platelet function if used for cardiovascular prevention.
**Clinical Pearls**
* The enteric coating helps reduce gastric upset but does not eliminate the risk of gastrointestinal bleeding.
* Crushing or chewing enteric-coated tablets negates the protective coating and should be avoided.
* Low-dose aspirin (75-325 mg) is commonly used for secondary prevention of cardiovascular events, but the specific dose and indication require careful patient assessment.
* Concomitant use with alcohol can increase the risk of gastrointestinal irritation and bleeding.
* Discontinue aspirin at least 5-7 days before elective surgery.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and local protocols for definitive guidance.
