aspirin (Rx, OTC)

Brand and Other Names:Bayer Buffered Aspirin, Durlaza, more...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, Extended Release Bayer 8-Hour Caplets, Extra Strength Bayer Plus Caplets, Genuine Bayer Aspirin, Halfprin DSC, 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

  • 81mg

tablet, enteric-coated

  • 81mg
  • 162mg
  • 325mg
  • 650mg

extended-release capsule (Durlaza [Rx])

  • 162.5 mg

Pain and Fever

Immediate release: 325- 650 mg PO q4hr PRN or 975 mg PO q6hr PRN or 500-1,000 mg PO q4-6hr for no more than 10 days; not to exceed 4 g/day

Rectal: 300-600 mg PR q4hr for no more than 10 days or as directed by health care provider

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)

  • 81-325 mg PO qDay indefinitely (preferred dose); may give 81-325 mg/day
  • Regimen may depend on coadministered drugs or comorbid conditions
  • Extended-release capsule (Durlaza [Rx]): 162.5 mg PO qDay

Percutaneous transluminal coronary angioplasty

  • Adjunctive aspirin therapy to support reperfusion with primary PCI (with or without fibrinolytic therapy)
  • Preprocedure: 162-325 mg PO before procedure
  • Postprocedure: 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 ASCVD Prevention with Low-Dose Aspirin

Adults aged 40-70 years: Consider use of low-dose aspirin (75-100 mg PO qDay) for select adults who are at higher risk for atherosclerotic cardiovascular disease (ASCVD), but not at increased bleeding risk (AHA/ACC 2019 Guidelines on Primary Prevention of Cardiovascular Disease)

Adults aged >70 years: Low-dose aspirin should not be administered on a routine basis for primary prevention of ASCVD

Any age with increased bleeding risk: Do not administer low-dose aspirin for primary prevention

Note: There may be select circumstances where clinicians might discuss prophylactic aspirin with adults aged <40 yr or >70 yr in the context of other known ASCVD risk factors (eg, strong family history of premature MI, inability to achieve lipid or BP or glucose targets, or significant elevation in coronary artery calcium score)

Ischemic Stroke & Transient Ischemic Attack

Initial: 160-325 mg PO within 48 hr of stroke/TIA onset, followed by 75-100 mg PO qDay

AHA/ASA recommends an initial dose of 325 mg within 24-48 hr after stroke; do not administer aspirin within 24 hr after administration of alteplase

Maintenance (secondary prevention)

  • Extended-release capsule (Durlaza [Rx]): 162.5 mg PO qDay

Anti-Inflammatory

Use of non-aspirin NSAIDs has largely supplanted the use of aspirin for osteoarthritis, rheumatoid arthritis, and other inflammatory arthritides

Immediate release: Usual maintenance dose: 2.1-7.3 g/day in divided doses (individualize dose); monitor serum salicylate 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

Pain and Fever

<50 kg

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

≥50 kg

  • Immediate release: 325-650 mg PO/PR q4-6hr PRN; not to exceed 4 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

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Interactions

Interaction Checker

and aspirin

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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

            Pregancy

            Avoid chronic or intermittent high doses during pregnancy; may affect maternal and newborn hemostasis mechanisms, leading to an increased risk of hemorrhage

            High doses may also increase perinatal mortality by intrauterine growth restriction and teratogenic effects

            Near term, aspirin may prolong gestation and labor

            Premature closure of the ductus arteriosus may occur if used near term with use of full-dose aspirin

            Seek advice of health professional before using OTC drugs during pregnancy

            Lactation

            Drug enters breast milk; a decision should be made regarding whether to discontinue nursing or to discontinue drug, taking into account importance of drug to mother

            Seek advice of health professional before using OTC drugs while breastfeeding

            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.

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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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            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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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.