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# Ecospirin (Aspirin, Enteric-Coated)
## Overview
Ecospirin is an enteric-coated formulation of acetylsalicylic acid (ASA), an irreversible inhibitor of cyclooxygenase-1 (COX-1). The enteric coating is designed to delay disintegration until the tablet reaches the small intestine, intended to reduce gastric mucosal irritation.
## Primary Indications
* Secondary prevention of myocardial infarction (MI) and ischemic stroke.
* Prevention of cardiovascular events in high-risk patients.
* Acute treatment of ST-segment elevation myocardial infarction (STEMI) or unstable angina (non-enteric preferred for acute loading).
## Adult Dosing
* **Secondary Prevention/Antiplatelet:** 75 mg to 162 mg orally once daily. 81 mg is the standard low-dose strength.
* **Acute Coronary Syndrome (Initial):** 162 mg to 325 mg (chewed, non-enteric preferred for rapid absorption).
* **Maximum Daily Dose:** Generally 4,000 mg for analgesic/anti-inflammatory use, but limited to 325 mg daily for chronic antiplatelet therapy.
## Pediatric Dosing
* **Kawasaki Disease:** 80 mg/kg/day to 100 mg/kg/day (divided every 6 hours) during the initial acute febrile phase; decrease to 3–5 mg/kg/day once fever subsides.
* **Rheumatic Fever:** 80 mg/kg/day to 100 mg/kg/day (divided every 4–6 hours).
* **Antiplatelet:** Not routinely indicated in children unless directed by a specialist (e.g., congenital heart disease).
* **Warning:** **Strictly avoid for viral infections (influenza/varicella) due to the risk of Reye’s syndrome.**
## Dose Adjustments
* **Renal Impairment:** Use with caution in severe impairment (CrCl <10 mL/min).
* **Hepatic Impairment:** Avoid in severe hepatic failure.
* **Geriatric:** Increased risk of GI bleeding; consider proton pump inhibitor (PPI) co-therapy if risk factors are present.
## Contraindications
* Hypersensitivity to salicylates or NSAIDs.
* Active pathological bleeding (e.g., peptic ulcer, intracranial hemorrhage).
* Asthma associated with aspirin or NSAID-induced bronchospasm.
* Children and teenagers with viral infections (Reye's syndrome risk).
* Use within 7 days of surgery (if high bleeding risk identified by surgeon).
## Adverse Effects
* **Common:** Dyspepsia, nausea, abdominal pain.
* **Serious:** Gastrointestinal ulceration/bleeding, hypersensitivity reactions (anaphylaxis, angioedema), intracranial hemorrhage, hearing loss/tinnitus (usually with high chronic doses).
## Key Drug Interactions
* **NSAIDs (e.g., Ibuprofen):** May interfere with the antiplatelet effect of low-dose aspirin; space dosing (aspirin 30 mins before or 8 hours after ibuprofen).
* **Anticoagulants (e.g., Warfarin, DOACs):** Increased synergistic risk of major bleeding.
* **P2Y12 Inhibitors:** Increased bleeding risk.
* **Corticosteroids:** May decrease salicylate serum concentrations and increase risk of GI ulceration.
## Monitoring
* **GI:** Monitor for signs of occult bleeding (melena, hematemesis, unexplained anemia).
* **Labs:** Periodic hemoglobin/hematocrit if long-term therapy is used.
* **Renal Function:** Monitor in patients with baseline renal insufficiency.
## Clinical Pearls
* **Absorption:** Enteric coating prevents rapid absorption; it should **never** be used in an emergency setting where rapid platelet inhibition is required. In emergencies, use plain, non-enteric aspirin.
* **Reye's Syndrome:** A severe, rare condition causing encephalopathy and fatty liver; reinforce absolute avoidance in pediatric patients with fever or viral symptoms.
* **Adherence:** Low-dose aspirin is a cornerstone of secondary prevention; maintain consistent daily use to prevent "aspirin resistance" or rebound pro-thrombotic states.
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*Disclaimer: This information is for educational purposes only. Clinical protocols and local guidelines may vary. Always verify current prescribing information, contraindications, and drug interactions via official pharmacy databases (e.g., UpToDate, Lexicomp, or local formulary) before prescribing or administering medication.*
