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# Ecospirin (Aspirin, Enteric-Coated)
## Overview
Ecospirin is an enteric-coated formulation of acetylsalicylic acid (ASA), an irreversible COX-1 and COX-2 inhibitor. The enteric coating is designed to bypass the stomach and dissolve in the small intestine to minimize direct gastric mucosal irritation.
## Primary Indications
* Prophylaxis of myocardial infarction (MI) and stroke.
* Secondary prevention of cardiovascular events.
* Management of acute coronary syndrome (ACS).
* Anti-inflammatory, analgesic, and antipyretic purposes (less common with enteric-coated due to delayed onset).
## Adult Dosing
* **Antiplatelet (Secondary Prevention/ACS):** 75 mg to 325 mg orally once daily. High-risk ACS presentations often utilize 162–325 mg for the initial loading dose (chewing non-enteric-coated is preferred for rapid absorption in emergencies).
* **Analgesic/Antipyretic:** 325 mg to 650 mg every 4 to 6 hours as needed. Maximum: 4,000 mg/day.
## Pediatric Dosing
* **Kawasaki Disease:** 80–100 mg/kg/day divided every 6 hours (acute phase), then 3–5 mg/kg/day (maintenance).
* **Rheumatic Fever:** 80–100 mg/kg/day divided every 4 to 6 hours.
* **Note:** Use in children is strictly limited due to the risk of **Reye’s Syndrome** following viral infections (influenza/varicella).
## Dose Adjustments
* **Renal Impairment:** Use with caution in severe impairment (CrCl <10 mL/min); high doses may increase risk of toxicity.
* **Hepatic Impairment:** Use with caution; monitor for increased bleeding risk due to hypoprothrombinemia.
## Contraindications
* Hypersensitivity to salicylates or NSAIDs.
* Active peptic ulcer disease or pathological bleeding.
* History of asthma induced by aspirin or other NSAIDs ("aspirin-exacerbated respiratory disease").
* Children or teenagers with viral infections (Reye’s syndrome risk).
* Third trimester of pregnancy (risk of premature closure of the ductus arteriosus).
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, nausea, occult blood loss (despite enteric coating).
* **Hematologic:** Increased bleeding time, thrombocytopenia.
* **Ototoxicity:** Tinnitus (a sign of salicylate toxicity).
* **Hypersensitivity:** Anaphylaxis, bronchospasm, urticaria.
## Key Drug Interactions
* **Anticoagulants/Antiplatelets (e.g., Warfarin, P2Y12 inhibitors, DOACs):** Potentially synergistic bleeding risk; monitor closely.
* **NSAIDs (e.g., Ibuprofen):** Ibuprofen may interfere with the antiplatelet effect of aspirin; separate doses by at least 8 hours.
* **Corticosteroids/SSRIs:** Increased risk of gastrointestinal ulceration and bleeding.
* **Methotrexate:** Aspirin increases methotrexate toxicity by reducing renal clearance.
## Monitoring
* **Efficacy:** Symptom resolution (pain) or cardiovascular status.
* **Safety:** Hemoglobin/Hematocrit (to detect occult bleeding), stools for occult blood, and baseline renal function.
* **Toxicity:** Monitor for tinnitus, confusion, or hyperventilation (salicylism).
## Clinical Pearls
* **Absorption:** Enteric coating significantly delays onset of action; *do not use* enteric-coated aspirin if rapid antiplatelet activity is required for acute MI; request non-enteric-coated for chewing.
* **Administration:** Swallow tablets whole; do not crush, break, or chew, as this destroys the enteric barrier and increases gastric irritation.
* **Perioperative:** Guidelines vary; generally, aspirin may be continued for minor procedures but must be evaluated by a surgeon/cardiologist for major surgeries due to bleeding risks.
* **Local Protocols:** Institutional protocols for ACS loading doses may vary; always consult local hospital formulary and cardiac guidelines.
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**Disclaimer:** This information is for educational purposes only and does not constitute medical advice. Always verify current prescribing information, institutional protocols, and patient-specific factors with the most recent clinical guidelines or pharmacological databases before prescribing or administering medication.
