Foundation® Pain Reliever
[OTC]; A.S.A. [OTC]; Ascriptin®[OTC]; Aspergum®[OTC];
Asprimox®[OTC]; Bayer® Aspirin [OTC]; Bayer® Buffered
Aspirin [OTC]; Bayer® Low Adult Strength [OTC];
Bufferin®[OTC]; Buffex®[OTC]; Cama® Arthritis Pain
Reliever [OTC]; Easprin®; Ecotrin®[OTC]; Ecotrin® Low
Adult Strength [OTC]; Empirin®[OTC]; Extra Strength
Adprin-B®[OTC]; Extra Strength Bayer® Enteric 500 Aspirin
[OTC]; Extra Strength Bayer® Plus [OTC]; Halfprin®
81®[OTC]; Heartline®[OTC]; Regular Strength Bayer®
Enteric 500 Aspirin
[OTC]; St Joseph® Adult Chewable Aspirin
|Apo®-ASA; ASA®; Asaphen;
Entrophen®; MSD® Enteric Coated ASA; Novasen|
Acetylsalicylic Acid; ASA|
Treatment of mild to moderate pain, inflammation, and fever; prophylaxis for
myocardial infarction and transient ischemic episodes; management of rheumatoid
arthritis, rheumatic fever, osteoarthritis, and gout (high
C (D if full-dose aspirin in 3rd trimester)
Hypersensitivity to salicylates or other NSAIDs; asthma; rhinitis; nasal
polyps; inherited or acquired bleeding disorders (including factor VII and
factor IX deficiency); pregnancy (in 3rd trimester especially); do not use in
children (<16 years of age) for viral infections (chickenpox or flu
symptoms), with or without fever, due to a potential association with Reye's
Use with caution in patients with platelet and bleeding disorders, renal
dysfunction, dehydration, erosive gastritis, or peptic ulcer disease. Heavy
alcohol use (>3 drinks/day) can increase bleeding risks. Avoid use in severe
renal failure or in severe hepatic failure. Discontinue use if tinnitus or
impaired hearing occurs. Caution in mild-moderate renal failure (only at high
dosages). Patients with sensitivity to tartrazine dyes, nasal polyps and asthma
may have an increased risk of salicylate sensitivity. Surgical patients should
avoid ASA if possible, for 1-2 weeks prior to surgery, to reduce the risk of
As with all drugs which may affect hemostasis, bleeding is associated with
aspirin. Hemorrhage may occur at virtually any site. Risk is dependent on
multiple variables including dosage, concurrent use of multiple agents which
alter hemostasis, and patient susceptibility. Many adverse effects of aspirin
are dose-related, and are rare at low dosages. Other serious reactions are
idiosyncratic, related to allergy or individual sensitivity. Accurate estimation
of frequencies is not possible. The reactions listed below have been reported
Cardiovascular: Hypotension, tachycardia, dysrhythmias, edema
Dermatologic: Rash, angioedema, urticaria
Endocrine and metabolic: Acidosis, hyperkalemia, dehydration, hypoglycemia
(children), hyperglycemia, hypernatremia (buffered forms)
Gastrointestinal: Nausea, vomiting, dyspepsia, epigastric discomfort,
heartburn, stomach pains, gastrointestinal ulceration (6% to 31%), gastric
erosions, gastric erythema, duodenal ulcers
Hematologic: Anemia, disseminated intravascular coagulation, prolongation of
prothrombin times, coagulopathy, thrombocytopenia, hemolytic anemia, bleeding,
iron deficiency anemia
Hepatic: Hepatotoxicity, increased transaminases, hepatitis (reversible)
Neuromuscular and skeletal: Rhabdomyolysis, weakness, acetabular bone
Otic: Hearing loss, tinnitus
Renal: Interstitial nephritis, papillary necrosis, proteinuria, renal
impairment, renal failure (including cases caused by rhabdomyolysis), increased
BUN, increased serum creatinine
Respiratory: Asthma, bronchospasm, dyspnea, laryngeal edema, hyperpnea,
tachypnea, respiratory alkalosis, noncardiogenic pulmonary edema
Miscellaneous: Anaphylaxis, prolonged pregnancy and labor, stillbirths, low
birth weight, peripartum bleeding, Reye's syndrome
Case reports: Colonic ulceration, esophageal stricture, esophagitis with
esophageal ulcer, esophageal hematoma, oral mucosal ulcers (aspirin-containing
chewing gum), coronary artery spasm, conduction defect and atrial fibrillation
(toxicity), delirium, ischemic brain infarction, colitis, rectal stenosis
(suppository), cholestatic jaundice, periorbital edema, rhinosinusitis
Refer to the nomogram in Toxicology Information in the Appendix
Treatment should also be based upon symptomatology. Toxic symptoms and
corresponding treatments are as follows:
- Overdose: Induce emesis with ipecac, and/or lavage with saline,
followed with activated charcoal
- Dehydration: I.V. fluids with KCl (no D5W only)
- Metabolic acidosis (must be treated): Sodium bicarbonate
- Hyperthermia: Cooling blankets or sponge baths
- Coagulopathy/hemorrhage: Vitamin K I.V.
- Hypoglycemia (with coma, seizures, or change in mental status):
Dextrose 25 g I.V.
- Seizures: Diazepam 5-10 mg I.V.
ACE inhibitors: The effects of ace inhibitors may be blunted by aspirin
administration, particularly at higher dosages.
Buspirone increases aspirin's free % in vitro.
Carbonic anhydrase inhibitors and corticosteroids have been associated with
alteration in salicylate serum concentrations.
Heparin and low molecular weight heparins: Concurrent use may increase the
risk of bleeding.
Methotrexate serum levels may be increased; consider discontinuing aspirin
2-3 days before high-dose methotrexate treatment or avoid concurrent use.
NSAIDs may increase the risk of gastrointestinal adverse effects and
bleeding. Serum concentrations of some NSAIDs may be decreased by aspirin.
Platelet inhibitors (IIb/IIa antagonists): Risk of bleeding may be increased.
Probenecid effects may be antagonized by aspirin.
Sulfonylureas: The effects of older sulfonylurea agents (tolazamide,
tolbutamide) may be potentiated due to displacement from plasma proteins. This
effect does not appear to be clinically significant for newer sulfonylurea
agents (glyburide, glipizide, glimepiride).
Valproic acid may be displaced from its binding sites which can result in
Verapamil may potentiate the prolongation of bleeding time associated with
Warfarin and oral anticoagulants may increase the risk of bleeding.
Keep suppositories in refrigerator, do not freeze; hydrolysis of aspirin
occurs upon exposure to water or moist air, resulting in salicylate and acetate,
which possess a vinegar-like odor; do not use if a strong odor is
Inhibits prostaglandin synthesis, acts on the hypothalamus heat-regulating
center to reduce fever, blocks prostaglandin synthetase action which prevents
formation of the platelet-aggregating substance thromboxane
Duration: 4-6 hours
Absorption: From stomach and small intestine
Distribution: Readily distributes into most body fluids and tissues
Metabolism: Hydrolyzed to salicylate (active) by esterases in the GI mucosa,
red blood cells, synovial fluid and blood; metabolism of salicylate occurs
primarily by hepatic microsomal enzymes; metabolic pathways are saturable
Half-life: Parent drug: 15-20 minutes; Salicylates (dose-dependent): From 3
hours at lower doses (300-600 mg), to 5-6 hours (after 1 g) to 10 hours with
Time to peak serum concentration: ~1-2 hours
Analgesic and antipyretic: Oral, rectal: 10-15 mg/kg/dose every 4-6 hours, up
to a total of 60-80 mg/kg/24 hours
Anti-inflammatory: Oral: Initial: 60-90 mg/kg/day in divided doses; usual
maintenance: 80-100 mg/kg/day divided every 6-8 hours, maximum dose: 3.6 g/day;
monitor serum concentrations
Kawasaki disease: Oral: 80-100 mg/kg/day divided every 6 hours; after fever
resolves: 8-10 mg/kg/day once daily; monitor serum concentrations
Antirheumatic: Oral: 60-100 mg/kg/day in divided doses every 4 hours
Analgesic and antipyretic: Oral, rectal: 325-650 mg every 4-6 hours up to 4
Anti-inflammatory: Oral: Initial: 2.4-3.6 g/day in divided doses; usual
maintenance: 3.6-5.4 g/day; monitor serum concentrations
TIA: Oral: 1.3 g/day in 2-4 divided doses
Myocardial infarction prophylaxis: 160-325 mg/day; a lower aspirin dosage has
been recommended in patients receiving ACE inhibitors
Dosing adjustment in renal impairment: Clcr <10
mL/minute: Avoid use.
Hemodialysis: Dialyzable (50% to 100%)
Dosing adjustment in hepatic disease: Avoid use in severe liver
Alcohol: Combination causes GI irritation, possible bleeding; avoid or limit
alcohol. Patients at increased risk include those prone to hypoprothrombinemia,
vitamin K deficiency, thrombocytopenia, thrombotic thrombocytopenia purpura,
severe hepatic impairment, and those receiving anticoagulants.
Food: May decrease the rate but not the extent of oral absorption. Drug may
cause GI upset, bleeding, ulceration, perforation. Take with food or large
volume of water or milk to minimize GI upset.
Folic acid: Hyperexcretion of folate; folic acid deficiency may result,
leading to macrocytic anemia. Supplement with folic acid if necessary.
Iron: With chronic aspirin use and at doses of 3-4 g/day, iron deficiency
anemia may result; supplement with iron if necessary
Sodium: Hypernatremia resulting from buffered aspirin solutions or sodium
salicylate containing high sodium content. Avoid or use with caution in CHF or
any condition where hypernatremia would be detrimental.
Curry powder, paprika, licorice, Benedictine liqueur, prunes, raisins, tea
and gherkins: Potential salicylate accumulation. These foods contain 6 mg
salicylate/100 g. An ordinarily American diet contains 10-200 mg/day of
salicylate. Foods containing salicylates may contribute to aspirin
hypersensitivity. Patients at greatest risk for aspirin hypersensitivity include
those with asthma, nasal polyposis or chronic urticaria.
Fresh fruits containing vitamin C: Displaces drug from binding sites,
resulting in increased urinary excretion of aspirin. Educate patients regarding
the potential for a decreased analgesic effect of aspirin with consumption of
foods high in vitamin C.
Timing of serum samples: Peak levels usually occur 2 hours after ingestion.
Salicylate serum concentrations correlate with the pharmacological actions and
adverse effects observed. The serum salicylate concentration (mcg/mL) and the
corresponding clinical correlations are as follows:
Desired effects: Antiplatelet, antipyresis, analgesia
Adverse effects/Intoxication: GI intolerance and bleeding, hypersensitivity,
Serum salicylate level 150-300
Desired effects: Anti-inflammatory
Adverse effects/Intoxication: Mild salicylism
Serum salicylate level 250-400
Desired effects: Treatment of rheumatic fever
Adverse effects/Intoxication: Nausea/vomiting, hyperventilation, salicylism,
flushing, sweating, thirst, headache, diarrhea, and tachycardia
Serum salicylate level >400-500
Adverse effects/Intoxication: Respiratory alkalosis, hemorrhage, excitement,
confusion, asterixis, pulmonary edema, convulsions, tetany, metabolic acidosis,
fever, coma, cardiovascular collapse, renal and respiratory failure
False-negative results for glucose oxidase urinary glucose tests
(Clinistix®); false-positives using the cupric sulfate
method (Clinitest®); also, interferes with Gerhardt test,
VMA determination; 5-HIAA, xylose tolerance test and T3 and
The most dramatic benefits of aspirin are evident when used in the treatment
of myocardial infarction. Time is of the essence. Therapy should be acutely
initiated as 325 mg of nonenteric-coated aspirin, preferably chewed if possible.
While the optimum dose of aspirin in ischemic heart disease is not known, 325 mg
is generally the dose of choice; 80 mg doses are used in patients who are less
tolerant of aspirin therapy. The morbidity and mortality benefit from aspirin
therapy after infarction is similar to the benefit achieved by thrombolytic
therapy. The benefits of these therapeutic interventions are additive. Aspirin
therapy is also indicated in patients with atrial fibrillation to prevent
thromboembolic events. In this setting, aspirin is indicated in those patients
with atrial fibrillation who are <65 years of and age and who have no other
risk factors for stroke.
|Mental Health: Effects
on Mental Status|
May cause drowsiness
Effects on Psychiatric
May cause leukopenia; use caution with clozapine and carbamazepine; may
displace valproic acid from binding sites resulting in an increase of unbound
drug; monitor for toxicity
|Dental Health: Local
No information available to require special precautions
Effects on Dental Treatment|
Avoid aspirin, if possible, for 1 week prior to surgery because of the
possibility of postoperative bleeding
If self-administered, use exactly as directed (do not increase dose or
frequency); adverse reactions can occur with overuse. Take with food or milk. Do
not use aspirin with strong vinegar-like odor. Do not crush or chew extended
release products. While using this medication, avoid alcohol, excessive amounts
of vitamin C, or salicylate-containing foods (curry powder, prunes, raisins,
tea, or licorice), other prescription or OTC medications containing aspirin or
salicylate, or other NSAIDs without consulting prescriber. Maintain adequate
hydration (2-3 L/day of fluids unless instructed to restrict fluid intake). You
may experience nausea, vomiting, gastric discomfort (frequent mouth care, small
frequent meals, sucking lozenges, or chewing gum may help). GI bleeding,
ulceration, or perforation can occur with or without pain. May discolor stool
(pink/red). Stop taking aspirin and report ringing in ears; persistent pain in
stomach; unresolved nausea or vomiting; difficulty breathing or shortness of
breath; unusual bruising or bleeding (mouth, urine, stool); or skin rash.
Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend
to be pregnant. Consult prescriber if breast-feeding.
Do not crush sustained release or enteric coated tablet
Capsule: 356.4 mg and caffeine 30 mg
Suppository, rectal: 60 mg, 120 mg, 125 mg, 130 mg, 195 mg, 200 mg, 300 mg,
325 mg, 600 mg, 650 mg, 1.2 g
Tablet: 65 mg, 75 mg, 81 mg, 325 mg, 500 mg
Tablet: 400 mg and caffeine 32 mg
Buffered: 325 mg and magnesium-aluminum hydroxide 150 mg; 325 mg, magnesium
hydroxide 75 mg, aluminum hydroxide 75 mg, buffered with calcium carbonate; 325
mg and magnesium-aluminum hydroxide 75 mg
Chewable: 81 mg
Controlled release: 800 mg
Delayed release: 81 mg
Enteric coated: 81 mg, 325 mg, 500 mg, 650 mg, 975 mg
Gum: 227.5 mg
Timed release: 650 mg
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