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# Ecospirin (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
* Pain and inflammation (though less common for chronic use due to risk profile compared to other NSAIDs)
* Primary and secondary prevention of cardiovascular events (e.g., myocardial infarction, stroke)
* Kawasaki disease (arteritis)
## Adult Dosing
* **Cardiovascular Prevention:** Typically 81 mg to 162 mg once daily. Higher doses (e.g., 325 mg) may be used initially in specific acute situations.
* **Pain/Inflammation:** Doses vary widely, typically starting at 325 mg to 650 mg every 4-6 hours as needed. Maximum dose generally not to exceed 4000 mg per day. Dosing depends on indication and local protocols.
## Pediatric Dosing
* **Kawasaki Disease:** Following initial IVIG, aspirin 30-50 mg/kg/day divided into 2-4 doses. Once afebrile for 48-72 hours, reduce to 3-5 mg/kg/day once daily.
* **Pain/Fever:** Generally **avoided** in children and adolescents due to the risk of Reye's syndrome, especially during viral illnesses. If absolutely indicated and alternative therapies are not suitable, specific pediatric protocols must be followed, typically under specialist guidance. Dosing is based on weight.
## Dose Adjustments
* No specific dose adjustments are typically needed for renal or hepatic impairment for low-dose antiplatelet therapy. Higher doses for pain/inflammation may require caution in moderate-to-severe impairment.
## Contraindications
* Hypersensitivity to aspirin, salicylates, or NSAIDs.
* Bleeding disorders.
* Active peptic ulceration or recent gastrointestinal bleeding.
* Severe renal or hepatic impairment.
* Use in children and adolescents with viral infections (risk of Reye's syndrome).
* Third trimester of pregnancy.
## Adverse Effects
Common: Gastric upset, heartburn, dyspepsia, nausea.
Serious: Gastrointestinal bleeding, ulceration, perforation, tinnitus, hearing loss, bronchospasm (especially in aspirin-sensitive asthma), angioedema, Stevens-Johnson syndrome, Reye's syndrome (in children/adolescents), prolonged bleeding time.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, DOACs):** 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.
* **SSRIs/SNRIs:** Increased risk of bleeding.
* **Methotrexate:** Aspirin can increase methotrexate toxicity.
* **Uricosuric agents (e.g., probenecid):** Aspir
