aspirin (Rx, OTC)Zorprin, Bayer Buffered Aspirin, more...

Classes: Antiplatelet Agents, Cardiovascular;

Antiplatelet Agents, Hematologic;
NSAIDs;
Salicylates

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BEGIN#: Left Nav
Dosing & Uses
Interactions
Adverse Effects
Warnings
Pregnancy
Pharmacology
Images
Patient Handout
END#: Left Nav

Dosing & Uses

AdultPediatric
Dosage Forms & Strengths
tablet
81mg
325mg
500mg
tablet, delayed-release
162mg
325mg
500mg
tablet, chewable
75mg
81mg
tablet, enteric-coated

81mg
162mg
325mg
650mg
gum, chewing, oral
227mg
extended-release capsule (Durlaza [Rx])
162.5 mg
Pain & Fever
325-650 mg PO/PR q4-6hr PRN
Controlled/extended/delayed-release products (enteric-coated): 6501300 mg PO q8hr; not to exceed 3.9 g/day
Acute Coronary Syndrome
For use as adjunctive antithrombotic effects for ACS (ST-segment
elevation myocardial infarction [STEMI], unstable angina [UA]/non-STsegment elevation myocardial infarction [NSTEMI])
Acute symptoms
160-325 mg PO; chew nonenteric-coated tablet upon
presentation (within minutes of symptoms)
If unable to take PO, may give 300-600 mg suppository PR
Maintenance (secondary prevention)
75-81 mg PO qDay indefinitely (preferred dose); may give 81-325
mg/day
Regimen may depend on coadministered drugs or comorbid
conditions
Coadministered with ticagrelor: 81 mg PO qDay
Percutaneous transluminal coronary angioplasty
Adjunctive aspirin therapy to support reperfusion with primary PCI
(with or without fibrinolytic therapy)
Preoperative dose: 162-325 mg PO before procedure
Maintenance: 81 mg PO qDay indefinitely (preferred dose) may
give 81-325 mg/day
Regimen may depend on coadministered drugs or comorbid
conditions
Coadministered with ticagrelor: 81 mg PO qDay
Primary & Secondary Prevention
Durlaza: Indicated to reduce the risk of death and MI in patients with
chronic CAD (eg, history of MI, unstable angina, or chronic stable
angina); also indicated to reduce the risk of death and recurrent stroke
in patients who have had an ischemic stroke or TIA
Extended-release capsule (Durlaza [Rx]): 162.5 mg PO qDay
Use immediate-release aspirin, not extended release capsule in
situations where a rapid onset of action of action is required (such as
acute treatment of myocardial infarction or before percutaneous

coronary intervention)
Ischemic Stroke & Transient Ischemic Attack
50-325 mg/day PO within 48 hours of stroke or TIA, then 75-100
mg/day PO
Osteoarthritis
Up to 3 g/day PO in divided doses
Rheumatoid Arthritis
3 g/day PO in divided doses; increased PRN for anti-inflammatory
efficacy (target plasma salicylate, 150-300 mcg/mL)
Spondyloarthropathy
3.6-5.4 g/day PO in divided doses; monitor serum concentrations
Colorectal Cancer (Off-label)
Prophylaxis
600 mg/day PO
Decreases risk of developing hereditary colorectal cancer (ie, Lynch
syndrome) by 60% if taken daily for at least 2 years
Dosing Modifications
Renal impairment
CrCl >10 mL/min: Dose adjustment not necessary
CrCl <10 mL/min: Not recommended
Hepatic impairment
Severe liver disease: Not recommended

Pediatric
Dosage Forms & Strengths
tablet
81mg
325mg
500mg
tablet, delayed release
162mg
325mg
500mg
tablet, chewable
75mg
81mg
tablet, enteric coated
81mg
162mg
325mg
650mg
gum, chewing, oral
227mg
Pain & Fever
<12 years

10-15 mg/kg PO q4hr, up to 60-80 mg/kg/day

12 years
325-650 mg PO/PR q4-6hr PRN
Controlled/extended/delayed-release products (enteric coated):
650-1300 mg PO q8hr; not to exceed 3.9 g/day
Juvenile Rheumatoid Arthritis
<25 kg: 60-100 mg/kg/day PO divided q6-8hr (maintain serum salicylate
at 150-300 mcg/mL)
25 kg: 2.4-3.6 g/day
Kawasaki Disease
Febrile phase: 80-100 mg/kg/day PO divided q6hr for up to 14 days (4872 hours after fever defervescence)
Maintenance: 3-6 mg/kg/day PO in single dose
Dosing Considerations
Toxic dose: 200 mg/kg

Adverse Effects
Frequency Not Defined
Angioedema
Bronchospasm
CNS alteration
Dermatologic problems
GI pain, ulceration, bleeding
Hepatotoxicity
Hearing loss
Nausea
Platelet aggregation inhibition
Premature hemolysis
Pulmonary edema (salicylate-induced, noncardiogenic)
Rash
Renal damage
Tinnitus
Urticaria
Vomiting
Contraindications
Hypersensitivity to aspirin or NSAIDs; aspirin-associated
hypersensitivity reactions include aspirin-induced urticaria (HLADRB1*1302-DQB1*0609 haplotype), aspirin-intolerant asthma (HLADPB1*0301)
Allergy to tartrazine dye
Absolute
Bleeding GI ulcers, hemolytic anemia from pyruvate kinase (PK)
and glucose-6-phosphate dehydrogenase (G6PD) deficiency,
hemophilia, hemorrhagic diathesis, hemorrhoids, lactating mother, nasal
polyps associated with asthma, sarcoidosis, thrombocytopenia,
ulcerative colitis

Relative
Appendicitis, asthma (bronchial), chronic diarrhea, bowel outlet
obstruction (for enteric-coated formulations), dehydration, erosive
gastritis, hypoparathyroidism
Cautions
Anemia, GI malabsorption, history of peptic ulcers, gout, hepatic
disease, hypochlorhydria, hypoprothrombinemia, renal impairment,
thyrotoxicosis, vitamin K deficiency, renal calculi, ethanol use (may
increase bleeding)
Discontinue therapy if tinnitus develops
Should be taken with food or 8-12 oz of water to avoid GI effects
Not indicated for children with viral illness; use of salicylates in pediatric
patients with varicella or influenzalike illness is associated with
increased incidence of Reye syndrome

Pregnancy & Lactation

Pregnancy category: C; D in 3rd trimester (expert analysis); it is

especially important that patient not use aspirin during last 3 months of
pregnancy unless specifically directed to do so by doctor, because it
may cause problems in unborn child or complications during delivery.
Lactation: Drug enters breast milk; decision should be made regarding
whether to discontinue nursing or to discontinue drug, taking into
account importance of drug to mother.

Pharmacology
Mechanism of Action
Inhibits synthesis of prostaglandin by cyclooxygenase; inhibits platelet
aggregation; has antipyretic and analgesic activity
Absorption
Bioavailability: 80-100%
Onset: PO, 5-30 min; PR, 1-2 hr
Duration: PO, 4-6 hr; PR, >7 hr
Peak plasma time: PO, 0.25-3 hr
Peak plasma concentration: Analgesia/antipyresis, 30-100 mcg/mL;
anti-inflammatory, 150-300 mcg/mL
Distribution
Protein bound: 100 mcg/mL, 90-95%; 100-400 mcg/mL, 70-85%;
higher concentrations, 25-60%
Vd: 170 mL/kg
Metabolism
Metabolized by liver via microsomal enzyme system
Metabolites: Salicylurate, salicyl phenolic glucuronide, salicyl acyl
glucuronide, 2,5-dihydroxybenzoic acid (gentisic acid), 2,3dihydroxybenzoic acid, 2,3,5-trihydroxybenzoic acid, gentisuric acid
(active)
Enzymes inhibited: Cyclooxygenase (insignificant)
Elimination

Half-life: Low dose, 2-3 hr; higher dose, 15-30 hr

Renal clearance: 80-100% in 24-72 hr
Excretion: Urine (80-100%), sweat, saliva, feces
Dialyzable: Yes