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# Ecospirin (Aspirin, Enteric-Coated)
## Overview
Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis. Enteric coating delays absorption, reducing gastric irritation.
## Primary Indications
* **Cardiovascular Risk Reduction:** Primary and secondary prevention of myocardial infarction and stroke.
* **Pain and Inflammation:** Mild to moderate pain and inflammatory conditions (though other NSAIDs may be preferred for more potent anti-inflammatory effects).
* **Kawasaki Disease:** Adjunct therapy.
## Adult Dosing
* **Cardiovascular Risk Reduction:**
* **Primary Prevention:** 75-100 mg once daily.
* **Secondary Prevention:** 75-325 mg once daily. Higher doses (e.g., 325 mg) may be used initially after acute cardiovascular events, followed by a lower maintenance dose.
* **Pain and Inflammation:**
* **Pain:** 325-1000 mg every 4-6 hours as needed. Maximum 4000 mg/day.
* **Inflammation:** 2400-3600 mg/day in divided doses.
* **Kawasaki Disease:** 80-100 mg/kg/day in 4 divided doses (anti-inflammatory dose) until afebrile for 2-3 days, then reduced to 3-5 mg/kg/day once daily (antiplatelet dose) for at least 6-8 weeks.
## Pediatric Dosing
* **Kawasaki Disease:** See adult dosing.
* **Acute Rheumatic Fever:**
* **Initial:** 100 mg/kg/day divided every 6 hours.
* **Maintenance:** 0.5-1 g twice daily or 30 mg/kg/day divided twice daily for at least 6 weeks.
* **Pain and Fever:** Dosing is generally not recommended due to the risk of Reye's syndrome. When absolutely necessary for children over 2 years with fever or viral illness, use with extreme caution. Dosing is typically 10-15 mg/kg/dose every 4-6 hours. **Avoid in children/teenagers with viral infections.**
## Dose Adjustments
* **Renal Impairment:** Use with caution. Severe renal impairment may require dose reduction or avoidance.
* **Hepatic Impairment:** Use with caution.
## Contraindications
* Hypersensitivity to aspirin, salicylates, NSAIDs, or any component of the formulation.
* History of asthma, urticaria, or other allergic-type reactions to aspirin or NSAIDs.
* Children and teenagers with viral infections (influenza or varicella) due to the risk of Reye's syndrome.
* Active peptic ulcer disease or gastrointestinal bleeding.
* Bleeding disorders.
* Severe hepatic or renal impairment.
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, heartburn, nausea, vomiting, abdominal pain, erosions, ulcers, bleeding, perforation.
* **Hematologic:** Increased bleeding time, bruising, inhibition of platelet aggregation.
* **Auditory:** Tinnitus, hearing loss (more common with higher doses).
* **Respiratory:** Bronchospasm (especially in aspirin-sensitive asthma).
* **Renal:** Renal papillary necrosis, interstitial nephritis, renal failure (with chronic high doses).
* **Dermatologic:** Rash, urticaria.
* **Other:** Reye's syndrome (in children/teenagers with viral infections).
## Key Drug Interactions
* **Anticoagulants/Antiplatelets (e.g., warfarin, clopidogrel, heparin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Alcohol:** Increased risk of GI bleeding.
* **Methotrexate:** Aspirin can increase methotrexate levels, potentially leading to toxicity.
* **Uricosuric agents (e.g., probenecid, sulfinpyrazone):** Aspirin impairs the uricosuric effect.
* **Antihypertensives (e.g., ACE inhibitors, ARBs, beta-blockers):** Can decrease their efficacy.
* **NSAIDs:** Additive gastrointestinal and bleeding risks.
## Monitoring
* Signs and symptoms of GI bleeding (melena, hematemesis, abdominal pain).
* Signs of bleeding elsewhere (easy bruising, prolonged bleeding from cuts).
* Renal function, especially in patients with risk factors or on long-term therapy.
* Liver function, particularly with higher doses or prolonged use.
* Hearing (tinnitus) with higher doses.
## Clinical Pearls
* Enteric coating reduces gastric irritation but does not eliminate the risk of GI bleeding or ulceration.
* Should not be crushed or chewed to maintain enteric coating integrity.
* Use the lowest effective dose for the shortest duration necessary.
* Discontinue aspirin at least 5-7 days before elective surgery.
* Avoid in children and adolescents with viral illnesses due to Reye's syndrome risk.
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*Disclaimer: This information is intended for clinical use and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant guidelines before making any treatment decisions.*
