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# Ecospirin Enteric-Coated (Aspirin)
## Overview
Ecospirin Enteric-Coated is a brand name for aspirin, a nonsteroidal anti-inflammatory drug (NSAID) with analgesic, anti-inflammatory, and antipyretic properties. It also possesses antiplatelet activity. The enteric coating is designed to delay absorption and reduce gastric irritation.
## Primary Indications
* **Pain and Inflammation:** Mild to moderate pain and inflammatory conditions.
* **Cardiovascular Prevention:** Prevention of myocardial infarction and stroke in patients with established cardiovascular disease or at high risk.
* **Rheumatic Fever Prophylaxis:** Prevention of recurrence of rheumatic fever.
## Adult Dosing
* **Pain and Inflammation:**
* Typical dose: 325 mg to 650 mg every 4 to 6 hours as needed.
* Maximum daily dose: Generally not to exceed 4000 mg in 24 hours for anti-inflammatory effects, but lower limits are often preferred to minimize risk.
* **Cardiovascular Prevention (Primary and Secondary):**
* Low-dose (antiplatelet): 75 mg to 325 mg once daily. The optimal dose depends on the specific indication and local guidelines.
* **Rheumatic Fever Prophylaxis:**
* 325 mg twice daily.
## Pediatric Dosing
Aspirin is generally **avoided** in children and adolescents with viral infections (e.g., influenza, varicella) due to the risk of Reye's syndrome. Dosing for other indications is uncommon and should be determined by a physician based on specific circumstances.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Dose reduction may be necessary in severe renal impairment.
* **Hepatic Impairment:** Use with caution. Monitor liver function.
## Contraindications
* Hypersensitivity to aspirin, salicylates, NSAIDs, or any component of the formulation.
* History of aspirin-induced asthma, urticaria, or other allergic-type reactions.
* Active peptic ulcer disease.
* Bleeding disorders (e.g., hemophilia, thrombocytopenia).
* Severe hepatic or renal impairment.
* Children and adolescents with viral infections.
* Late pregnancy (third trimester).
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, nausea, vomiting, abdominal pain, heartburn, gastritis, GI bleeding, ulceration.
* **Hematologic:** Increased bleeding time, bruising, petechiae.
* **Hypersensitivity:** Bronchospasm, rash, urticaria, angioedema.
* **Renal:** Renal impairment, interstitial nephritis.
* **Hepatic:** Hepatotoxicity.
* **Other:** Tinnitus (especially at higher doses), dizziness, headache.
## 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.
* **Antihypertensives (e.g., ACE inhibitors, ARBs, beta-blockers):** Aspirin may decrease their efficacy.
* **Methotrexate:** Aspirin can decrease methotrexate clearance and increase its toxicity.
* **Uricosuric agents (e.g., probenecid):** Aspirin may reduce their effectiveness.
* **Alcohol:** Increased risk of GI bleeding.
## Monitoring
* Signs and symptoms of GI bleeding (melena, hematemesis, abdominal pain).
* Signs and symptoms of bruising or excessive bleeding.
* Renal and hepatic function, especially in patients with pre-existing impairment or those on long-term therapy.
* Tinnitus, as it may indicate toxicity.
## Clinical Pearls
* The enteric coating allows aspirin to pass through the stomach largely intact, dissolving in the small intestine. This may delay absorption but reduces gastric irritation.
* For immediate relief of pain or fever, non-enteric coated formulations may be preferred.
* Patients should be advised to avoid alcohol while taking aspirin to minimize GI risk.
* Discontinue aspirin at least 5-7 days before elective surgery.
* Patients with asthma, nasal polyps, and aspirin sensitivity are at increased risk of severe reactions.
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*This information is intended for clinical use and does not replace the need to consult official prescribing information and institutional protocols.*
