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# Aspirin, Enteric-Coated
## Overview
Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) with analgesic, antipyretic, and antiplatelet properties. The enteric coating is designed to delay absorption and reduce gastric irritation.
## Primary Indications
* **Cardiovascular prophylaxis:** Prevention of myocardial infarction and stroke in patients with established cardiovascular disease or risk factors.
* **Analgesia/Antipyresis:** Mild to moderate pain and fever.
* **Inflammation:** Rheumatic conditions.
## Adult Dosing
* **Cardiovascular prophylaxis:** Typically 81 mg to 325 mg once daily. Lower doses (e.g., 81 mg) are common for long-term prevention.
* **Analgesia/Antipyresis:** 325 mg to 650 mg every 4 to 6 hours as needed. Maximum daily dose is typically 4000 mg.
* **Inflammation:** 325 mg to 650 mg every 4 to 6 hours. Higher doses may be used under specialist supervision, up to 4000 mg to 6000 mg daily in divided doses.
## Pediatric Dosing
Aspirin is generally **avoided** in children and adolescents due to the risk of Reye's syndrome, especially during viral illnesses (e.g., influenza, varicella). Specific pediatric dosing guidelines for juvenile idiopathic arthritis exist but require careful risk-benefit assessment and contraindications should be strictly observed.
## Dose Adjustments
No specific dose adjustments are typically required for renal or hepatic impairment, however, caution is advised and lower doses may be considered due to increased risk of adverse effects.
## Contraindications
* Hypersensitivity to aspirin, salicylates, NSAIDs, or any component of the formulation.
* Asthma, urticaria, or allergic-type reactions precipitated by aspirin or other NSAIDs.
* Active peptic ulceration or gastrointestinal bleeding.
* Children and adolescents with viral infections (risk of Reye's syndrome).
* Inhibitors of Vitamin K synthesis (e.g., warfarin) when used for antiplatelet effects, except in specific comorbid conditions.
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, heartburn, nausea, vomiting, abdominal pain, occult blood loss, GI perforation, ulceration.
* **Hematologic:** Increased bleeding tendency, thrombocytopenia.
* **Hypersensitivity:** Bronchospasm, rash, angioedema, urticaria.
* **Other:** Tinnitus (especially at higher doses), dizziness, headache.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, heparin):** Increased risk of bleeding.
* **Other NSAIDs and COX-2 inhibitors:** Increased risk of gastrointestinal toxicity and bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **Diuretics and antihypertensives:** May decrease efficacy and increase risk of renal toxicity.
* **Methotrexate:** Aspirin may increase methotrexate toxicity.
* **Selective Serotonin Reuptake Inhibitors (SSRIs):** Increased risk of bleeding.
* **Valproic acid:** Aspirin may displace valproic acid from plasma protein binding sites.
## Monitoring
* **Bleeding:** Monitor for signs and symptoms of bleeding (e.g., bruising, melena, hematemesis).
* **Gastrointestinal symptoms:** Assess for dyspepsia, abdominal pain, or blood in stool.
* **Renal function:** Consider monitoring in patients with pre-existing renal disease or those at risk.
* **Auditory symptoms:** Tinnitus may indicate excessive dosage.
## Clinical Pearls
* The enteric coating allows for less frequent dosing and may reduce gastric upset compared to non-coated aspirin, but does not eliminate the risk of GI bleeding.
* Discontinue aspirin at least 5-7 days before elective surgery.
* Advise patients to avoid concurrent use of alcohol, which can increase the risk of GI bleeding.
* For cardiovascular protection, compliance with daily low-dose aspirin is crucial.
**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult with a qualified healthcare provider and refer to the most current prescribing information or professional guidelines before making any treatment decisions.
