Asprin

What is the Aspirin? 

Aspirin is used to reduce fever and relieve mild to moderate pain from conditions such as muscle aches, toothaches, common cold, and headaches. It may also be used to reduce pain and swelling in conditions such as arthritis. Aspirin is known as a salicylate and a nonsteroidal anti-inflammatory drug (NSAID).

Aspirin is one of the most widely used medications in the world with an estimated 40,000 tonnes of it being consumed each year. In countries where "Aspirin" is a registered trademark owned by Bayer, the generic term is acetylsalicylic acid (ASA)..





Blood clots that block flow to heart muscle cause heart attacks, and clots that block blood flow to the brain cause strokes. Aspirin reduces the risk of heart attacks and strokes by preventing platelets from forming blood clots on the surface of ruptured plaques. 

Each pill or capsule of regular-strength aspirin version typically contains 325 mg of the drug, while the extra-strength version is 500 mg. For headache pain, the recommended adult dose of aspirin is 325 to 650 mg every three to four hours as needed, up to six times per day.

Aspirin structure: 

C9H8O4

 

 

 

 

 

 

Aspirin Indications:

Treating minor aches and pains (eg, caused by headache, muscle aches, backache, arthritis, the common cold, toothache, menstrual cramps). It is used in certain patients to decrease the risk of stroke, heart attack, and death associated with stroke or heart attack. It may also be used for other conditions as determined by your doctor.

Aspirin is a salicylate. It works by inhibiting several different chemical processes within the body that cause pain, inflammation, and fever. It also reduces the tendency for blood to clot.

Do Not use Aspirin if:

• you are allergic to any ingredient in Aspirin
• you are a child or teenager with influenza (flu) or chicken pox
• you have bleeding problems such as hemophilia, von Willebrand disease, or low blood platelets
• you have had a severe allergic reaction (eg, severe rash, hives, breathing difficulties, dizziness) to aspirin, tartrazine, or an NSAID (eg, ibuprofen, naproxen, celecoxib)
• you are taking anticoagulants (eg, heparin, warfarin) or methotrexate

Contact your doctor or health care provider right away if any of these apply to you.

Before using Aspirin:

Some medical conditions may interact with Aspirin. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

• if you are pregnant, plan to become pregnant, or are breast-feeding
• if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
• if you have allergies to medicines or other substances
• f you have alcoholism or if you consume 3 or more alcohol-containing drinks every day
• if you have asthma, bleeding or clotting problems, growths in the nose (nasal polyps), kidney or liver problems, stomach or peptic ulcers (bleeding ulcers), heartburn, upset stomach, stomach pain, influenza (flu) or chicken pox, or vitamin K deficiency
• if you are a child with a stroke, a weakened blood vessel (cerebral aneurysm) or bleeding in the brain, or Kawasaki syndrome (a rare inflammation causing heart problems in children)

Some MEDICINES MAY INTERACT with Aspirin. Tell your health care provider if you are taking any other medicines, especially any of the following:

• Carbonic anhydrase inhibitors (eg, acetazolamide) because they may decrease Aspirin's effectiveness
• Anticoagulants (eg, heparin, warfarin) or nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, ibuprofen, celecoxib) because the risk of their side effects, including risk of bleeding, may be increased by Aspirin
• Insulin and oral antidiabetics (eg, glyburide, nateglinide) because the risk of their side effects, including low blood sugar (eg, hunger, shakiness or weakness, dizziness, headache, sweating), may be increased by Aspirin
• Methotrexate or valproic acid because the risk of their actions and side effects may be increased by Aspirin
• Angiotensin-converting enzyme inhibitors (eg, enalapril), probenecid, or sulfinpyrazone because their effectiveness may be decreased by Aspirin

This may not be a complete list of all interactions that may occur. Ask your health care provider if Aspirin may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

Possible side effects of Aspirin:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Heartburn; nausea; upset stomach.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); black or bloody stools; confusion; diarrhea; dizziness; drowsiness; hearing loss; ringing in the ears; severe stomach pain; vomiting.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects.

General information:

• If you have any questions about Aspirin, please talk with your doctor, pharmacist, or other health care provider.
• Aspirin is to be used only by the patient for whom it is prescribed. Do not share it with other people.
• If your symptoms do not improve or if they become worse, check with your doctor.
• Check with your pharmacist about how to dispose of unused medicine.

This information should not be used to decide whether or not to take Aspirin or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about Aspirin. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to Aspirin. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your healthcare provider for complete information about the risks and benefits of using Aspirin.

Dosages: 

Applies to the following strength(s): 800 mg ; 500 mg ; 325 mg ; 81 mg ; buffered 500 mg ; buffered 325 mg ; buffered 81 mg ; 975 mg ; 650 mg ; 125 mg ; 600 mg ; 60 mg ; 300 mg ; 162 mg ; 1 g ; 81 mg with phytosterols ; 227.5 mg ; 1200 mg ; 162.5 mg

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

Usual Adult Dose for Ankylosing Spondylitis

For treatment of inflammatory diseases such as ankylosing spondylitis, osteoarthritis, rheumatoid arthritis, and SLE-associated arthritis and pleurisy:

3 grams per day in divided doses (spondyloarthropathies may require up to 4 grams per day in divided doses).

Serum salicylate levels may be useful in guiding therapeutic decisions regarding dosage titration. Serum salicylate levels of 150 to 300 mcg/mL are associated with anti-inflammatory response. However, the incidence of toxicity increases with salicylate levels greater than 200 mcg/mL.

Usual Adult Dose for Osteoarthritis

For treatment of inflammatory diseases such as ankylosing spondylitis, osteoarthritis, rheumatoid arthritis, and SLE-associated arthritis and pleurisy:

3 grams per day in divided doses (spondyloarthropathies may require up to 4 grams per day in divided doses).

Serum salicylate levels may be useful in guiding therapeutic decisions regarding dosage titration. Serum salicylate levels of 150 to 300 mcg/mL are associated with anti-inflammatory response. However, the incidence of toxicity increases with salicylate levels greater than 200 mcg/mL.

Usual Adult Dose for Rheumatoid Arthritis

For treatment of inflammatory diseases such as ankylosing spondylitis, osteoarthritis, rheumatoid arthritis, and SLE-associated arthritis and pleurisy:

3 grams per day in divided doses (spondyloarthropathies may require up to 4 grams per day in divided doses).

Serum salicylate levels may be useful in guiding therapeutic decisions regarding dosage titration. Serum salicylate levels of 150 to 300 mcg/mL are associated with anti-inflammatory response. However, the incidence of toxicity increases with salicylate levels greater than 200 mcg/mL.

Usual Adult Dose for Systemic Lupus Erythematosus

For treatment of inflammatory diseases such as ankylosing spondylitis, osteoarthritis, rheumatoid arthritis, and SLE-associated arthritis and pleurisy:

3 grams per day in divided doses (spondyloarthropathies may require up to 4 grams per day in divided doses).

Serum salicylate levels may be useful in guiding therapeutic decisions regarding dosage titration. Serum salicylate levels of 150 to 300 mcg/mL are associated with anti-inflammatory response. However, the incidence of toxicity increases with salicylate levels greater than 200 mcg/mL.

Usual Adult Dose for Fever

325 to 650 mg orally or rectally every 4 hours as needed, not to exceed 4 g/day.

Usual Adult Dose for Pain

325 to 650 mg orally or rectally every 4 hours as needed, not to exceed 4 g/day.

Usual Adult Dose for Rheumatic Fever

80 mg/kg/day orally in 4 equally divided doses, up to 6.5 g/day.

Dosage may be adjusted according to patient response, tolerance, and serum salicylate levels (therapeutic range is 250 to 400 mcg/mL for rheumatic fever). Generally after 1 to 2 weeks, the dosage is decreased to approximately 60 to 70 mg/kg/day and given for an additional 1 to 6 weeks or longer if necessary, then gradually withdrawn over 1 to 2 weeks. An appropriate course of antibiotic therapy should be initiated at the time of diagnosis of rheumatic fever.

Usual Adult Dose for Myocardial Infarction

160 to 162.5 mg orally once a day beginning as soon as an acute myocardial infarction is suspected and continuing for 30 days. If a solid dose formulation is used, the first dose should be chewed, crushed, or sucked. Long-term aspirin therapy for secondary prevention is recommended after 30 days.

Usual Adult Dose for Ischemic Stroke

50 to 325 mg orally once a day. Therapy should be continued indefinitely.

Usual Adult Dose for Angina Pectoris

75 mg to 325 mg orally once a day beginning as soon as unstable angina is diagnosed and continuing indefinitely.

Usual Adult Dose for Angina Pectoris Prophylaxis

75 mg to 325 mg orally once a day, continued indefinitely.

Usual Adult Dose for Thromboembolic Stroke Prophylaxis

75 mg to 325 mg orally once a day, continued indefinitely.

Usual Adult Dose for Myocardial Infarction - Prophylaxis

75 mg to 325 mg orally once a day, continued indefinitely.

Usual Adult Dose for Ischemic Stroke - Prophylaxis

75 mg to 325 mg orally once a day, continued indefinitely.

Usual Adult Dose for Revascularization Procedures - Prophylaxis

For coronary artery bypass graft (CABG):
325 mg orally once a day beginning 6 hours after the procedure and continuing for 1 year or indefinitely as needed.

For percutaneous transluminal coronary angiography (PTCA):
325 mg orally once 2 hours prior to procedure, then 160 to 325 mg orally once a day indefinitely.

For carotid endarterectomy:
80 mg orally once a day up to 650 mg orally twice a day beginning prior to surgery and continuing indefinitely.

Usual Pediatric Dose for Fever

2 to 11 years: 10 to 15 mg/kg orally or rectally every 4 to 6 hours as needed, not to exceed 4 g/day.

12 years or older: 325 to 650 mg orally or rectally every 4 hours as needed, not to exceed 4 g/day.

Usual Pediatric Dose for Pain

2 to 11 years: 10 to 15 mg/kg orally or rectally every 4 to 6 hours as needed, not to exceed 4 g/day.

12 years or older: 325 to 650 mg orally or rectally every 4 hours as needed, not to exceed 4 g/day.

Usual Pediatric Dose for Juvenile Rheumatoid Arthritis

2 to 11 years or less than or equal to 25 kg:
Initial: 60 to 90 mg/kg/day orally in equally divided doses.
Maintenance: 80 to 100 mg/kg/day orally in equally divided doses; higher dosages, up to 130 mg/kg/day, may be necessary in some cases, not to exceed 5.4 g/day.

12 years or older or greater than 25 kg:
Initial: 2.4 to 3.6 g/day orally in equally divided doses.
Maintenance: 3.6 to 5.4 g/day orally in equally divided doses; higher dosages may be necessary in some cases.

Serum salicylate levels may be useful in guiding therapeutic decisions regarding dosage titration. Serum salicylate levels of 150 to 300 mcg/mL are associated with anti-inflammatory response. However, the incidence of toxicity increases with salicylate levels greater than 200 mcg/mL.

Usual Pediatric Dose for Kawasaki Disease

Initial (acute febrile period): 80 to 100 mg/kg/day orally or rectally in 4 equally divided doses every 4 to 6 hours for up to 14 days (until fever resolves for at least 48 hours).

Maintenance (postfebrile period): 3 to 5 mg/kg orally or rectally once daily. Patients without coronary artery abnormalities should continue low-dose aspirin for 6 to 8 weeks or until ESR and platelet count are normal. Patients with coronary artery abnormalities should continue low-dose aspirin therapy indefinitely.

Usual Pediatric Dose for Rheumatic Fever

90 to 130 mg/kg/day in equally divided doses every 4 to 6 hours, up to 6.5 mg/day.

Dosage may be adjusted according to patient response, tolerance, and serum salicylate levels (therapeutic range is 250 to 400 mcg/mL for rheumatic fever). Generally after 1 to 2 weeks, the dosage is decreased to approximately 60 to 70 mg/kg/day and given for an additional 1 to 6 weeks or longer if necessary, then gradually withdrawn over 1 to 2 weeks. An appropriate course of antibiotic therapy should be initiated at the time of diagnosis of rheumatic fever.

Usual Pediatric Dose for Prosthetic Heart Valves - Mechanical Valves

less than 1 month:
Full term neonate: Antiplatelet effects: Postoperative congenital heart repair or recurrent arterial ischemic stroke: Oral: Adequate neonatal studies have not been performed; neonatal dosage is derived from clinical experience and is not well established; suggested doses: 1 to 5 mg/kg/day as a single daily dose. Doses are typically rounded to a convenient amount (e.g., 1/4 of 81 mg tablet).

1 month and older:
6 to 20 mg/kg orally once daily.

Aspirin may be administered in combination with an oral anticoagulant if systemic embolism occurs despite achieving target INR levels, or it may be used with low-dose oral anticoagulant and dipyridamole when full-dose warfarin is contraindicated.

Renal Dose Adjustments

Detailed information concerning the pharmacokinetic disposition of aspirin in patients with renal dysfunction is not available. Aspirin should be used with caution in chronic renal insufficiency, since it may cause a transient decrease in renal function. The use of aspirin in patients with severe renal impairment (CrCl less than 10 mL/minute) is not recommended due to the potential for increased risk of salicylate toxicity.

Liver Dose Adjustments

The use of aspirin in patients with severe hepatic impairment is not recommended due to the potential for increased risk of clinically significant bleeding and other adverse effects.

Precautions

The use of aspirin is contraindicated in patients with the syndrome of asthma, rhinitis, and nasal polyps. Aspirin may cause severe urticaria, angioedema, or bronchospasm in these patients.

The risk of bleeding is increased in patients receiving aspirin. Inhibition of platelet function occurs even at low doses of aspirin. Aspirin should not be given to patients with inherited or acquired bleeding disorders or in patients with a recent history of gastrointestinal (GI) bleeding.

Aspirin should not be used in children or adolescents with chickenpox or influenza symptoms due to the association with Reye's syndrome.

Dialysis

Detailed information concerning the removal of aspirin by hemodialysis is not available. Some investigators have suggested that aspirin and/or salicylate may be removed by hemodialysis and that aspirin dosing should follow dialysis sessions.

Aspirin Side Effects

In Summary

More frequently reported side effects include: heartburn, epigastric distress, dyspepsia, and nausea. See below for a comprehensive list of adverse effects.

 For the Consumer

Applies to aspirin: oral capsules, oral gum, oral tablets, rectal suppositories
Side effects include:
Minor upper GI symptoms (dyspepsia)

Gastrointestinal

Endoscopically identifiable gastric mucosal lesions occur in most patients who receive a single dose of aspirin. Clinically evident gastrointestinal bleeding has been reported in as many as 3% of treated elderly patients. Anorectal ulceration and rectal stenosis have been reported in patients who abuse aspirin-containing rectal suppositories. One case-controlled study has suggested that an association between aspirin (and other NSAID) consumption and appendicitis may exist.

The risk of developing dyspeptic events (i.e., epigastric pain, heartburn, nausea, ulcers) is low in rheumatic patients with no prior gastrointestinal symptoms who receive low-dose (less than 650 mg/day) aspirin therapy.

Gastrointestinal side effects have included epigastric distress (in as many as 83% of patients treated with regular aspirin), abdominal discomfort or pain, endoscopically identifiable gastric mucosal lesions, nausea, and vomiting. More serious gastrointestinal effects include hemorrhage, peptic ulcers, perforation, small bowel enteropathy, and esophageal ulcerations.

Renal

The mechanism of an aspirin-induced decrease in renal function may be related to inhibition of renal prostaglandin synthesis with consequent decreases in renal blood flow. Vasodilating renal prostaglandins may be particularly important in patients who exhibit arterial underfilling (i.e. heart failure, cirrhosis). The administration of high doses of NSAIDs to such patients has produced acute renal failure in rare instances.

Renal side effects have included reduction in glomerular filtration rate (particularly in patients who are sodium restricted or who exhibit diminished effective arterial blood volume, such as patients with advanced heart failure or cirrhosis), interstitial nephritis, papillary necrosis, elevations in serum creatinine, elevations in blood urea nitrogen, proteinuria, hematuria, and renal failure.

Hematologic

Hematologic side effects have included increased blood fibrinolytic activity. In addition, hypoprothrombinemia, thrombocytopenia, thrombocyturia, megaloblastic anemia, and pancytopenia have been reported rarely. Aplastic anemia and eosinophilia have also been reported.

Hypersensitivity

The mechanism of aspirin-induced hypersensitivity may be related to an up-regulation of the 5-lipoxygenase pathway of arachidonic acid metabolism with a resulting increase in the products of 5-lipoxygenase (such as leukotrienes).
Hypersensitivity side effects have included bronchospasm, rhinitis, conjunctivitis, urticaria, angioedema, and anaphylaxis. Approximately 10% to 30% of asthmatics are aspirin-sensitive (with the clinical triad of aspirin sensitivity, bronchial asthma, and nasal polyps).

Dermatologic

Dermatologic side effects have included Stevens-Johnson syndrome and a lichenoid eruption. In addition, isolated cases of unilateral aquagenic wrinkling of the palms and papuloerythroderma have been associated with aspirin therapy.

Hepatic

Hepatic side effects have included hepatotoxicity and cholestatic hepatitis.

Oncologic

Oncologic side effects have included reports of pancreatic cancer. Several epidemiologic studies have suggested that chronic aspirin use may decrease the risk of large bowel neoplasms. However, other studies have not found such a beneficial effect.

Metabolic

Metabolic side effects have included dehydration and hyperkalemia. Respiratory alkalosis and metabolic acidosis, particularly during salicylate toxicity, have been reported. A case of hypoglycemia has been reported in a patient on hemodialysis. Salicylates have also been reported to displace triiodothyronine (T3) and thyroxine (T4) from protein binding sites. The initial effect is an increase in serum free T4 concentrations.

Cardiovascular

A 29-year-old female with a history of migraine developed chest pain, tachycardia and orthopnea following aspirin consumption at doses of 1500 mg per day for several days. After discontinuation of aspirin therapy, the patient's symptoms promptly resolved. The patient consented to a pharmacological challenge test which once again triggered the symptoms.
Cardiovascular side effects have included salicylate-induced variant angina, ventricular ectopy, conduction abnormalities, and hypotension, particularly during salicylate toxicity. In addition, at least one case of fluid retention simulating acute congestive heart failure has been reported during aspirin therapy. Antiplatelet therapy has also been associated with acute deterioration of intracerebral hemorrhage.

Nervous system

Central nervous system side effects have included agitation, cerebral edema, coma, confusion, dizziness, headache, cranial hemorrhage, lethargy and seizures. Tinnitus and subjective hearing loss (or both) may occur. Some investigators have reported that modest doses may result in decreased frequency selectivity and may therefore impair hearing performance, particularly in the setting of background noise.
Some investigators have suggested that tinnitus may be a less reliable indicator of salicylate toxicity than previously believed. Patients with high frequency hearing loss may have difficulty perceiving tinnitus. In a study of rheumatoid arthritis patients, those with tinnitus had no greater salicylate levels than those without tinnitus. Elderly patients may be less likely to perceive tinnitus than younger patients.

Other

Reye's syndrome typically involves vomiting, neurologic dysfunction, and hepatic dysfunction during or shortly after an acute viral infection.
Other side effects have included Reye's syndrome with aspirin use in children with an acute viral illness. Reye's syndrome has also been reported even more rarely in adults.

Musculoskeletal

Musculoskeletal side effects have included rhabdomyolysis.

Respiratory

Respiratory side effects have included hyperpnea, pulmonary edema, and tachypnea.
Aspirin desensitization has been used to decrease disease activity and reduce the need for systemic corticosteroids in patients with aspirin-exacerbated respiratory disease^.

Endocrine

Endocrine side effects have included hypoglycemia (which has been reported in children) and hyperglycemia.

 

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