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# Ecospirin (Aspirin, Enteric-Coated)
## Overview
Ecospirin contains enteric-coated aspirin, a nonsteroidal anti-inflammatory drug (NSAID) with analgesic, antipyretic, and antiplatelet properties. The enteric coating is designed to delay release until the small intestine, reducing gastric irritation.
## Primary Indications
* Pain and inflammation (analgesic and anti-inflammatory)
* Fever (antipyretic)
* Prevention of cardiovascular events (antiplatelet)
## Adult Dosing
* **Pain/Fever:** 325 mg to 1000 mg every 4 to 6 hours as needed. Maximum daily dose typically 4000 mg.
* **Cardiovascular Prevention (Secondary):** 75 mg to 325 mg daily.
* **Cardiovascular Prevention (Primary - shared decision making):** 75 mg to 100 mg daily.
* **Kawasaki Disease:** Dosing is highly variable and often based on patient weight and phase of illness, typically ranging from 3-5 mg/kg/day (antiplatelet dose) to 80-100 mg/kg/day (anti-inflammatory dose). *Consult specific pediatric cardiology guidelines.*
## Pediatric Dosing
* **Pain/Fever:** Generally **not recommended** in children and teenagers due to the risk of Reye's syndrome, especially during viral illnesses. If absolutely indicated and no alternatives exist, specific dosing is weight-based (e.g., 10-15 mg/kg/dose orally every 4-6 hours). Use with extreme caution and only when benefits outweigh risks.
* **Kawasaki Disease:** As described in adult dosing under cardiovascular prevention. *Consult specific pediatric cardiology guidelines.*
## Dose Adjustments
* **Renal Impairment:** Use with caution. Severe impairment may require dose reduction or discontinuation.
* **Hepatic Impairment:** Use with caution. May be contraindicated in severe impairment.
## Contraindications
* Known hypersensitivity to aspirin, salicylates, or NSAIDs.
* Asthma, urticaria, or other allergic-type reactions after taking aspirin or other NSAIDs.
* Active peptic ulceration or gastrointestinal bleeding.
* Rare inherited problems of galactose intolerance, glucose-galactose malabsorption or total lactase deficiency (if formulation contains lactose).
* Children and teenagers with viral infections (e.g., influenza, chickenpox) due to risk of Reye's syndrome.
* Third trimester of pregnancy (risk of premature closure of ductus arteriosus).
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, nausea, vomiting, abdominal pain, occult bleeding, frank GI bleeding, ulceration.
* **Hematologic:** Increased bleeding time, bruising, petechiae, epistaxis, prolonged bleeding from wounds. Thrombocytopenia, anemia.
* **Hypersensitivity:** Bronchospasm, urticaria, angioedema, anaphylaxis.
* **Auditory:** Tinnitus, hearing loss (especially with higher doses).
* **Renal:** Acute kidney injury, interstitial nephritis.
* **Hepatic:** Elevated liver enzymes, hepatotoxicity.
* **Reye's Syndrome:** In children and adolescents with viral infections.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, heparin, DOACs):** Increased risk of bleeding.
* **Other NSAIDs/COX-2 Inhibitors:** Additive GI toxicity and increased bleeding risk.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **SSRIs/SNRIs:** Increased risk of bleeding.
* **Methotrexate:** Aspirin can decrease methotrexate clearance, increasing toxicity.
* **Antihypertensives (e.g., ACE inhibitors, ARBs, beta-blockers):** NSAIDs can reduce their efficacy and increase the risk of renal impairment.
* **Uricosuric agents (e.g., probenecid):** Aspirin can decrease the efficacy of these agents.
* **Valproic acid:** Aspirin can displace valproic acid from plasma protein binding sites, increasing free valproic acid levels.
## Monitoring
* **Signs of GI bleeding:** Melena, hematemesis, abdominal pain.
* **Signs of bleeding/bruising:** Especially if on anticoagulants or other antiplatelet agents.
* **Renal function:** BUN, creatinine, especially in patients with pre-existing renal disease or those taking nephrotoxic agents.
* **Liver function:** LFTs, particularly with chronic use or high doses.
* **Auditory symptoms:** Tinnitus, hearing loss.
## Clinical Pearls
* Enteric-coated aspirin should not be crushed or chewed; swallow whole.
* Take with a full glass of water. Avoid taking immediately before lying down.
* The risk of GI bleeding is dose-dependent and increases with age, history of PUD, concurrent use of alcohol, corticosteroids, or anticoagulants.
* For cardiovascular prevention, low-dose aspirin (75-100 mg) is typically used.
* Discontinue aspirin at least 5-7 days before elective surgery.
* **Crucially, avoid aspirin in children and adolescents with viral illnesses due to the risk of Reye's syndrome.**
**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines for accurate and complete dosing, indications, and safety information before making clinical decisions. Local protocols may also dictate specific dosing strategies.
