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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 reduce gastrointestinal upset by delaying dissolution until the drug reaches the small intestine.
## Primary Indications
* **Cardiovascular Prophylaxis:** Prevention of myocardial infarction and stroke in patients with established cardiovascular disease, history of transient ischemic attack (TIA), or diagnosed atherosclerotic cardiovascular disease.
* **Analgesia and Antipyresis:** Relief of mild to moderate pain and fever.
* **Inflammation:** Reduction of inflammation associated with conditions like arthritis.
## Adult Dosing
* **Cardiovascular Prophylaxis:**
* **Secondary Prevention:** 75 mg to 100 mg orally once daily. Some guidelines suggest up to 325 mg once daily for specific indications (e.g., post-myocardial infarction, post-stent placement), but lower doses are generally preferred for long-term use to minimize bleeding risk.
* **Primary Prevention:** The decision to use aspirin for primary prevention is individualized based on cardiovascular risk assessment and bleeding risk. If used, doses typically range from 75 mg to 100 mg orally once daily.
* **Analgesia and Antipyresis:**
* 325 mg to 650 mg orally every 4 to 6 hours as needed.
* Maximum dose: 4000 mg per day.
* **Inflammation (e.g., Rheumatoid Arthritis):**
* 325 mg to 650 mg orally every 4 to 6 hours, or higher doses up to 3.6 to 5.4 grams per day in divided doses, under close medical supervision.
## Pediatric Dosing
Aspirin is generally **NOT recommended** for use in children and teenagers with viral infections (e.g., influenza, chickenpox) due to the risk of Reye's syndrome. For other indications, dosing is weight-based and should be determined by a physician.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Dose reduction may be necessary in severe renal impairment.
* **Hepatic Impairment:** Use with caution.
## Contraindications
* Hypersensitivity to aspirin, salicylates, NSAIDs, or any component of the formulation.
* History of aspirin-induced asthma, urticaria, or other allergic-type reactions.
* Active gastrointestinal bleeding or ulceration.
* Children and teenagers with viral infections (risk of Reye's syndrome).
* Bleeding disorders.
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, nausea, vomiting, abdominal pain, heartburn, GI bleeding, ulceration, perforation.
* **Hematologic:** Increased bleeding time, bruising, epistaxis, prolonged bleeding from cuts.
* **Hypersensitivity:** Bronchospasm, angioedema, urticaria, rash.
* **Auditory:** Tinnitus, hearing loss (especially at higher doses).
* **Renal:** Renal insufficiency, interstitial nephritis.
* **Hepatic:** Hepatotoxicity (rare).
* **Reye's Syndrome:** In children and adolescents with viral infections.
## 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.
* **Alcohol:** Increased risk of GI bleeding.
* **Methotrexate:** Increased methotrexate toxicity.
* **Uricosuric agents (e.g., probenecid):** Decreased efficacy of uricosuric agents.
* **Antihypertensives (e.g., ACE inhibitors, ARBs, beta-blockers):** May decrease antihypertensive effect and increase risk of renal impairment.
* **Valproic acid:** Increased valproic acid levels.
## Monitoring
* **GI Symptoms:** Monitor for signs of GI irritation, bleeding (e.g., melena, hematemesis), or ulceration.
* **Bleeding:** Monitor for signs of bleeding, particularly in patients with risk factors.
* **Renal Function:** Monitor renal function, especially in patients with pre-existing renal disease or those on concomitant nephrotoxic agents.
* **Hepatic Function:** Monitor hepatic function if liver disease is present or suspected.
* **Tinnitus:** May indicate therapeutic toxicity.
## Clinical Pearls
* The enteric coating helps to minimize gastric irritation but does not eliminate the risk of GI bleeding or ulceration, especially with chronic use or higher doses.
* For cardiovascular prophylaxis, low-dose aspirin (75-100 mg) is typically preferred to balance efficacy with bleeding risk.
* Discontinue aspirin at least 5-7 days before elective surgery.
* Patients taking aspirin for cardiovascular prophylaxis should not stop the medication abruptly without consulting their healthcare provider, as this can increase the risk of thrombotic events.
* Enteric-coated aspirin should not be crushed or chewed.
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*Please verify this information with the most current prescribing information and relevant clinical guidelines.*
