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# Ecospirin (Aspirin, Enteric-Coated)
## Overview
Ecospirin is an enteric-coated formulation of aspirin, a nonsteroidal anti-inflammatory drug (NSAID) that inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin and thromboxane synthesis. The enteric coating delays dissolution until the small intestine, reducing gastric irritation.
## Primary Indications
* Secondary prevention of cardiovascular events (myocardial infarction, stroke) in patients with established cardiovascular disease or risk factors.
* Management of pain and fever (though less common for enteric-coated formulations due to slower onset).
* Prevention of pre-eclampsia in select pregnant individuals.
## Adult Dosing
* **Cardiovascular prevention:** Typically 81 mg to 325 mg once daily. Higher doses (e.g., 325 mg) may be used for initial loading doses or specific indications, but lower doses are preferred for long-term secondary prevention.
* **Pain/Fever:** Doses vary widely, typically 325 mg to 650 mg every 4 hours as needed, not to exceed 4 grams per day. Specific indications may require different dosing.
* **Pre-eclampsia prevention:** 60 mg to 81 mg once daily, usually started between 12 and 28 weeks of gestation.
## Pediatric Dosing
* **Pain/Fever:** Dosing is typically based on weight (e.g., 10-15 mg/kg/dose every 4-6 hours). **Use in children and adolescents is generally avoided due to the risk of Reye's syndrome**, especially during viral illnesses. Exceptions may exist for specific diagnoses under close medical supervision.
## Dose Adjustments
* No specific dose adjustments are routinely required for hepatic or renal impairment, but caution is advised. Aspirin is often avoided in severe renal or hepatic disease.
## Contraindications
* Hypersensitivity to aspirin or other NSAIDs.
* History of aspirin-induced asthma, urticaria, or other allergic-type reactions.
* Active gastrointestinal bleeding or peptic ulcer disease.
* Bleeding disorders.
* Severe hepatic or renal insufficiency.
* Children and adolescents with viral infections (risk of Reye's syndrome).
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, nausea, vomiting, abdominal pain, GI bleeding, ulceration.
* **Hematologic:** Increased bleeding risk, bruising, petechiae.
* **Hypersensitivity:** Bronchospasm (especially in asthmatics), urticaria, angioedema.
* **Other:** Tinnitus (especially at higher doses), dizziness, headache.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, DOACs):** Increased risk of bleeding.
* **Other NSAIDs and Corticosteroids:** Increased risk of GI bleeding and ulceration.
* **Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):** Increased risk of bleeding.
* **Methotrexate:** Aspirin can increase methotrexate toxicity.
* **Valproic acid:** Aspirin can displace valproic acid from protein binding sites, increasing free valproic acid levels.
* **Uricosurics (e.g., probenecid):** Aspirin can antagonize the uricosuric effect.
* **Alcohol:** Increased risk of GI bleeding.
## Monitoring
* Signs and symptoms of GI bleeding (melena, hematemesis, abdominal pain).
* Signs of excessive bleeding (bruising, prolonged bleeding from cuts).
* Renal function (especially in patients with risk factors).
* Tinnitus for signs of salicylism at higher doses.
## Clinical Pearls
* The enteric coating is designed to protect the stomach but does not eliminate the risk of GI bleeding, especially with chronic use or higher doses.
* Crushing or chewing enteric-coated tablets negates the protective coating and is not recommended.
* Aspirin should be discontinued several days prior to elective surgery to minimize bleeding risk.
* In cases of acute overdose, tinnitus is an early sign of salicylism.
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*Disclaimer: This information is intended for educational purposes only and does not substitute for professional medical advice. Always consult the most current prescribing information and your healthcare provider for diagnosis and treatment decisions.*
