aspirin (Rx, OTC)

Brand and Other Names:Zorprin, Bayer Buffered Aspirin, more...Durlaza, Asatab, Adprin-B, Alka-Seltzer Extra Strength with Aspirin, Alka-Seltzer with Aspirin, Arthritis Pain Formula, Ascriptin, Ascriptin Maximum Strength, ASA, Bayer Children's Aspirin, Bayer Women's Low Dose, Bayer Low Adult Strength, Bayer Advanced Aspirin, Bayer Extra Strength, Bayer Extra Strength Plus, Bufferin, Bufferin Extra Strength, Ecotrin, Ecotrin Maximum Strength, Empirin, Extended Release Bayer 8-Hour Caplets, Extra Strength Bayer Plus Caplets, Genuine Bayer Aspirin, Halfprin, Maximum Bayer Aspirin, St. Joseph Adult Chewable Aspirin, St. Joseph Regular Strength, acetylsalicylic acid
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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
more...

Pain & Fever

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

Acute Coronary Syndrome

For use as adjunctive antithrombotic effects for ACS (ST-segment elevation myocardial infarction [STEMI], unstable angina [UA]/non-ST-segment 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

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
more...

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 (48-72 hours after fever defervescence) 

Maintenance: 3-6 mg/kg/day PO in single dose

Dosing Considerations

Toxic dose: 200 mg/kg

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Interactions

Interaction Checker

and aspirin

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            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

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            Warnings

            Contraindications

            Hypersensitivity to aspirin or NSAIDs; aspirin-associated hypersensitivity reactions include aspirin-induced urticaria (HLA-DRB1*1302-DQB1*0609 haplotype), aspirin-intolerant asthma (HLA-DPB1*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

            Heart Failure (HF) risk

            • NSAIDS have the potential to trigger HF by prostaglandin inhibition that leads to sodium and water retention, increased systemic vascular resistance, and blunted response to diuretics
            • High-dose aspirin (greater than 325mg) should be avoided or withdrawn whenever possible
            • AHA/ACC Heart Failure Guidelines; Circulation. 2016; 134
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            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.

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
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            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), 2,3-dihydroxybenzoic 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

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            Formulary

            FormularyPatient Discounts

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            • View the formulary and any restrictions for each plan.
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            • Compare formulary status to other drugs in the same class.
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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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