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# Aspirin, Enteric-Coated
## Overview
Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) with analgesic, antipyretic, and anti-inflammatory properties. It also possesses antiplatelet activity. The enteric coating is designed to delay absorption and reduce gastric irritation.
## Primary Indications
* **Cardiovascular Protection:** Prevention of myocardial infarction and stroke in patients with a history of these events or at high risk.
* **Pain and Inflammation:** Relief of mild to moderate pain and reduction of inflammation (less common indication for enteric-coated formulations due to slow onset).
## Adult Dosing
* **Cardiovascular Protection:** Typically 75-325 mg once daily. For acute situations (e.g., suspected myocardial infarction), a higher loading dose (e.g., 162-325 mg chewed) may be used, followed by a maintenance dose.
* **Pain and Inflammation:** 325-650 mg every 4 hours, or 500-1000 mg every 4-6 hours as needed. Maximum daily dose is generally 4000 mg.
## Pediatric Dosing
Aspirin is generally **contraindicated** in children and adolescents younger than 19 years of age with viral infections (e.g., influenza or varicella) due to the risk of Reye's syndrome. Specific pediatric dosing for approved indications is not established for this formulation.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Dose reductions may be necessary in severe renal impairment.
* **Hepatic Impairment:** Use with caution.
## Contraindications
* Known hypersensitivity to aspirin, NSAIDs, or salicylates.
* Asthma, urticaria, or other allergic-type reactions after taking aspirin or other NSAIDs.
* Children and adolescents (<19 years) with viral infections.
* Active peptic ulcer disease or gastrointestinal bleeding.
* Certain bleeding disorders.
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, nausea, vomiting, abdominal pain, heartburn, epigastric distress, risk of occult or gross GI bleeding.
* **Hemorrhagic:** Increased risk of bleeding (including epistaxis, bruising, and prolonged bleeding time).
* **Hypersensitivity:** Bronchospasm, dyspnea, rash, urticaria.
* **Other:** Tinnitus, dizziness.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, heparin, DOACs):** Increased risk of bleeding.
* **Other NSAIDs and COX-2 Inhibitors:** Increased risk of GI toxicity and bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Diuretics and Antihypertensives:** May reduce the efficacy of these drugs; increased risk of NSAID-induced nephropathy.
* **Methotrexate:** Aspirin can increase methotrexate toxicity.
* **Antidiabetic Agents:** May potentiate hypoglycemia.
* **Uricosuric Agents (e.g., probenecid):** Aspirin can reduce the uricosuric effect.
## Monitoring
* **Signs and symptoms of GI bleeding:** Melena, hematochezia, abdominal pain.
* **Signs and symptoms of bleeding:** Easy bruising, epistaxis, prolonged bleeding from cuts.
* **Renal function:** Particularly with long-term use or in patients with risk factors.
* **Platelet function:** If clinically indicated.
* **Tinnitus:** May indicate salicylate toxicity.
## Clinical Pearls
* Enteric-coated aspirin is designed to be swallowed whole and **should not be crushed, chewed, or broken** to preserve the coating.
* Onset of action for pain relief is slower with enteric-coated aspirin compared to immediate-release formulations.
* For acute cardiovascular events (e.g., suspected MI), chewable aspirin (non-enteric coated) is preferred for faster absorption.
* Long-term daily low-dose aspirin therapy significantly increases the risk of GI bleeding and should be used judiciously.
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*This information is intended for healthcare professionals. Always consult the latest official prescribing information and relevant guidelines for complete and current details.*
