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# Aspirin, Enteric-Coated
## Overview
Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) with analgesic, antipyretic, anti-inflammatory, and antiplatelet properties. The enteric coating is designed to reduce gastric irritation.
## Primary Indications
* Pain and fever
* Inflammatory conditions (e.g., rheumatoid arthritis)
* Prophylaxis of cardiovascular events (e.g., myocardial infarction, stroke) in patients with established cardiovascular disease or at high risk.
## Adult Dosing
* **Pain/Fever:** 325 mg to 650 mg orally every 4 to 6 hours as needed. Maximum dose: Not well established for acute symptoms, but daily doses typically do not exceed 4000 mg.
* **Inflammation:** 2000 mg to 4000 mg orally per day in divided doses.
* **Cardiovascular Prophylaxis:**
* Primary prevention: 75-100 mg orally once daily.
* Secondary prevention: 75-325 mg orally once daily. Low-dose (75-100 mg) is often preferred for long-term use to minimize bleeding risk.
Dosing for specific indications may vary based on local protocols and patient factors.
## Pediatric Dosing
Aspirin is generally **not recommended** for children and teenagers due to the risk of Reye's syndrome, a rare but serious condition. Exceptions may exist in specific inflammatory conditions under strict medical supervision, with dosing typically based on weight (e.g., 10-15 mg/kg/day divided every 6-8 hours for Kawasaki disease).
## Dose Adjustments
No specific dose adjustments are typically required for renal or hepatic impairment, but caution is advised.
## Contraindications
* Hypersensitivity to aspirin, salicylates, NSAIDs, or any component of the formulation.
* Children and teenagers with viral infections (e.g., influenza, chickenpox) due to risk of Reye's syndrome.
* History of NSAID-induced asthma, urticaria, or allergic-type reactions.
* Active peptic ulcer disease.
* Bleeding disorders.
## Adverse Effects
Common: Gastrointestinal upset, heartburn, nausea, vomiting, abdominal pain.
Serious: Gastrointestinal bleeding, perforation, tinnitus, hearing loss, bronchospasm, urticaria, angioedema, Reye's syndrome (in children/teenagers), renal impairment, exacerbation of heart failure.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, heparin, DOACs):** Increased risk of bleeding.
* **Other NSAIDs (including COX-2 inhibitors):** Increased risk of gastrointestinal toxicity and potential for additive analgesic effects.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **SSRIs and SNRIs:** Increased risk of bleeding.
* **Methotrexate:** Aspirin may increase methotrexate toxicity.
* **Uricosuric agents (e.g., probenecid):** Aspirin can decrease the efficacy of uricosuric agents.
* **Valproic acid:** Aspirin can displace valproic acid from plasma protein binding sites, increasing free valproic acid levels.
## Monitoring
* **For GI Effects:** Monitor for signs and symptoms of bleeding (melena, hematemesis, abdominal pain).
* **For Cardiovascular Use:** Monitor for therapeutic efficacy and signs/symptoms of bleeding.
* **For Inflammatory Conditions:** Monitor for therapeutic response and adverse effects (GI, tinnitus).
* **Renal function** may be monitored, especially in patients with risk factors for renal impairment or those on long-term, high-dose therapy.
## Clinical Pearls
* The enteric coating delays absorption and reduces gastric irritation but does not eliminate the risk of GI bleeding.
* Crushing or chewing enteric-coated aspirin will destroy the coating and should be avoided.
* Aspirin should be used cautiously in patients with asthma, nasal polyps, or a history of hypersensitivity reactions to NSAIDs.
* In cases of overdose, tinnitus is an early sign.
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*Always verify current prescribing information and guidelines before initiating or modifying therapy.*
