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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 delay absorption and reduce gastrointestinal irritation.
## Primary Indications
* **Cardiovascular risk reduction:** Prevention of thrombotic events (e.g., myocardial infarction, stroke) in patients with established cardiovascular disease or risk factors.
* **Analgesia and antipyresis:** Relief of mild to moderate pain and fever (less common use for enteric-coated formulations due to delayed onset).
* **Inflammation:** Treatment of inflammatory conditions (less common use for enteric-coated formulations).
## Adult Dosing
* **Cardiovascular prevention:** Typically 81 mg to 325 mg once daily. For secondary prevention after an acute coronary syndrome, higher doses may be used initially, followed by maintenance therapy.
* **Analgesia/Antipyresis/Inflammation:** Doses vary widely depending on indication; however, enteric-coated formulations are generally not preferred for acute symptom relief due to delayed absorption.
## Pediatric Dosing
Aspirin is **generally avoided** in children and adolescents due to the risk of Reye's syndrome, especially during viral infections (e.g., influenza, chickenpox). Specific indications and expert consultation are required if use is considered.
## Dose Adjustments
* **Renal Impairment:** Use with caution in severe renal impairment. No specific dose adjustment recommendations; however, consider risks and benefits.
* **Hepatic Impairment:** Use with caution in hepatic impairment. No specific dose adjustment recommendations; however, consider risks and benefits.
## Contraindications
* Known 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 ulcer disease or gastrointestinal bleeding.
* Children and adolescents with viral infections.
* Inherited disorders of platelet coagulation.
* Severe hepatic or renal impairment.
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, heartburn, nausea, abdominal pain, GI bleeding, ulceration, perforation.
* **Hematologic:** Increased bleeding time, bruising, petechiae, epistaxis, prolonged hemorrhage.
* **Hypersensitivity:** Bronchospasm, urticaria, angioedema, anaphylaxis.
* **Renal:** Renal insufficiency, interstitial nephritis.
* **Other:** Tinnitus, hearing loss (especially at higher doses), dizziness.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, DOACs):** Increased risk of bleeding.
* **Other NSAIDs (including COX-2 inhibitors) and salicylates:** Increased risk of GI toxicity and additive antiplatelet effects.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Antihypertensives:** May reduce the antihypertensive effect.
* **Methotrexate:** Aspirin can decrease methotrexate clearance, increasing toxicity.
* **Antidiabetic agents:** May potentiate hypoglycemia.
* **Uricosuric agents (e.g., probenecid):** Aspirin may decrease the efficacy of uricosuric agents.
* **Alcohol:** Increased risk of GI irritation and bleeding.
## Monitoring
* Signs and symptoms of GI bleeding (melena, hematemesis, abdominal pain).
* Signs of bruising or excessive bleeding.
* Renal and hepatic function, especially in patients with pre-existing organ dysfunction or those receiving chronic therapy.
* Tinnitus or hearing changes, which may indicate toxicity.
## Clinical Pearls
* Enteric-coated aspirin should not be crushed or chewed; swallow whole to maintain coating integrity.
* For acute cardiovascular events (e.g., suspected MI), non-enteric coated aspirin is preferred for faster absorption.
* The antiplatelet effect of aspirin is irreversible and lasts for the life of the platelet (7-10 days).
* Discontinue aspirin at least 5-7 days prior to elective surgery if clinically feasible.
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*This information is intended for healthcare professionals and does not replace the need to consult the official prescribing information or a qualified healthcare provider for specific patient management decisions.*
