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# Ecospirin (aspirin, Enteric-Coated)
## Overview
Aspirin is a non-steroidal anti-inflammatory drug (NSAID) that inhibits cyclooxygenase (COX) enzymes, thereby reducing prostaglandin synthesis. Enteric coating delays absorption until it reaches the small intestine, which may reduce gastric irritation.
## Primary Indications
* **Cardiovascular Prophylaxis:** Primary and secondary prevention of cardiovascular events (e.g., myocardial infarction, stroke).
* **Analgesia and Antipyresis:** Mild to moderate pain and fever.
* **Inflammatory Conditions:** Rheumatoid arthritis, osteoarthritis (though higher doses are typically required for significant anti-inflammatory effects).
## Adult Dosing
* **Cardiovascular Prophylaxis:**
* **Primary Prevention:** 75-100 mg once daily. Generally reserved for select patients based on risk assessment; the benefit in primary prevention is debated and depends on individual risk factors.
* **Secondary Prevention:** 75-325 mg once daily. Higher doses (e.g., 325 mg) may be used initially after an acute event, then reduced.
* **Analgesia/Antipyresis:** 325-650 mg every 4-6 hours as needed. Maximum daily dose is typically 4000 mg.
* **Inflammatory Conditions:** Doses vary widely, often starting at 2400-3600 mg per day, divided into 3-4 doses. High-dose therapy requires careful monitoring.
## Pediatric Dosing
Aspirin is generally **not recommended** for use in children and adolescents younger than 19 years due to the risk of Reye's syndrome, especially during viral illnesses (e.g., influenza, varicella). Established pediatric dosing for specific indications is limited and typically managed by specialists.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Dose reduction may be necessary in severe renal impairment (CrCl < 10 mL/min).
* **Hepatic Impairment:** Use with caution.
## Contraindications
* Known hypersensitivity to aspirin, salicylates, NSAIDs, or any component of the formulation.
* Asthma, urticaria, or other allergic-type reactions precipitated by aspirin or other NSAIDs.
* Patients with the triad of asthma, nasal polyps, and aspirin intolerance.
* Children and adolescents with viral infections (risk of Reye's syndrome).
* Active peptic ulceration or recent gastrointestinal bleeding.
* Bleeding disorders (e.g., hemophilia, thrombocytopenia).
* Severe hepatic or renal impairment.
* Third trimester of pregnancy.
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, heartburn, nausea, vomiting, abdominal pain, occult bleeding, significant GI ulceration, and hemorrhage.
* **Hematologic:** Increased bleeding time, bruising, petechiae, epistaxis, prolonged bleeding from wounds.
* **Hypersensitivity:** Bronchospasm, dyspnea, urticaria, angioedema, rhinitis.
* **Other:** Tinnitus (especially with higher doses), dizziness, headache, Reye's syndrome (in children/adolescents with viral illness).
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, heparin, DOACs):** Increased risk of bleeding. Concurrent use requires careful consideration and monitoring.
* **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:** Aspirin can decrease methotrexate clearance, increasing toxicity risk.
* **Uricosuric agents (e.g., probenecid):** Aspirin can reduce the efficacy of uricosuric agents.
* **Antihypertensives (e.g., ACE inhibitors, ARBs, beta-blockers):** NSAIDs may reduce the effectiveness of these drugs.
## Monitoring
* **Bleeding:** Signs and symptoms of GI bleeding (melena, hematemesis, abdominal pain) and other bleeding (easy bruising, epistaxis).
* **Renal Function:** Especially in patients with pre-existing renal disease or those on concomitant nephrotoxic agents.
* **Hepatic Function:** Particularly with long-term, high-dose use.
* **Tinnitus:** Can be an early sign of salicylate toxicity.
## Clinical Pearls
* Enteric-coated aspirin should **not** be crushed or chewed.
* Take with a full glass of water.
* For cardiovascular use, consistency is key; typically taken once daily.
* The risk of GI bleeding increases with higher doses, longer duration of therapy, older age, concurrent use of other NSAIDs or anticoagulants, and history of GI ulceration.
* Discontinue aspirin several days before elective surgery if clinically appropriate.
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**Disclaimer:** This information is intended as a concise overview and does not replace a thorough review of the current prescribing information, clinical guidelines, or consultation with a healthcare professional. Always verify the most up-to-date drug information before making therapeutic decisions.
