aspirin (acetylsalicylic acid, ASA)

HIGH ALERT

as-pir-in (Asaphen E.C. , Ascriptin, Bayer, Bufferin, Ecotrin, Entrophen , Halfprin, Novasen , ZORprin) Do not confuse aspirin or Ascriptin with Afrin, Aricept, or Asendin, Ecotrin with Epogen, or ZORprin with Zyloprim.

Rapidly and completely absorbed from GI tract; enteric-coated absorption delayed; rectal absorption delayed and incomplete. Protein binding: High. Widely distributed. Rapidly hydrolyzed to salicylate. Half-life: 1520 min (aspirin); 23 hrs (salicylate at low dose); more than 20 hrs (salicylate at high dose).

USES
Treatment of mild to moderate pain, fever. Reduces inammation related to rheumatoid arthritis (RA), juvenile arthritis, osteoarthritis, rheumatic fever. As platelet aggregation inhibitor in the prevention of transient ischemic attacks (TIAs), cerebral thromboembolism, MI or reinfarction. Adjunctive treatment of Kawasakis disease. OFF-LABEL: Prevention of preeclampsia; alternative therapy for preventing thromboembolism associated with atrial brillation where warfarin cannot be used; pericarditis associated with MI; prosthetic valve thromboprophylaxis.

FIXED-COMBINATION(S)
Aggrenox: aspirin/dipyridamole (an antiplatelet agent): 25 mg/200 mg. Fiorinal: aspirin/butalbital/caffeine (a barbiturate): 325 mg/50 mg/40 mg. Lortab/ASA: aspirin/hydrocodone (an analgesic): 325 mg/5 mg. Percodan: aspirin/oxycodone (an analgesic): 325 mg/2.25 mg, 325 mg/4.5 mg. Pravigard: aspirin/ pravastatin (a cholesterol-lowering agent): 81 mg/20 mg, 81 mg/40 mg, 81 mg/80 mg, 325 mg/20 mg, 325 mg/40 mg, 325 mg/80 mg.
u CLASSIFICATION PHARMACOTHERAPEUTIC: Nonsteroidal salicylate. CLINICAL: Anti-

PRECAUTIONS
Hypersensitivity to salicylates, NSAIDs; asthma, rhinitis, nasal polyps; inherited or acquired bleeding disorders; use in children for viral infections; pregnancy. Cautions: Platelet/ bleeding disorders, severe renal/hepatic impairment, dehydration, erosive gastritis, peptic ulcer disease, sensitivity to tartrazine dyes.
Contraindications:

inammatory, antipyretic, anticoagulant (see pp. 32C, 127C).

ACTION
Inhibits prostaglandin synthesis, acts on the hypothalamus heat-regulating center, interferes with production of thromboxane A, a substance that stimulates platelet aggregation. Therapeutic Effect: Reduces inammatory response, intensity of pain; decreases fever; inhibits platelet aggregation.

LIFESPAN CONSIDERATIONS
Pregnancy/Lactation: Readily crosses

placenta; distributed in breast milk. May prolong gestation and labor; decrease fetal birth weight; increase incidence of stillbirths, neonatal mortality, hemorrhage. Avoid use during last trimester (may adversely affect fetal cardiovascular system: premature closure of ductus arteriosus). Pregnancy Category C (D if

PHARMACOKINETICS
Route PO Onset 1 hr Peak 24 hrs Duration 46 hrs

with acute febrile illness (Reyes syndrome). Elderly: May be more suscep-

full dose used in third trimester of pregnancy). Children: Caution in those

herb underlined top prescribed drug

tible to toxicity; lower dosages recommended.

INDICATIONS/ROUTES/DOSAGE
mg q46h. CHILDREN: 1015 mg/kg/dose q46h. Maximum: 4 g/day.
Anti-Inammatory PO: ADULTS, ELDERLY: Analgesia, Fever PO, RECTAL: ADULTS, ELDERLY: 325650

INTERACTIONS
Alcohol, NSAIDs may increase risk of GI effects (e.g., ulceration). Antacids, urinary alkalinizers increase excretion. Anticoagulants, heparin, thrombo lytics increase risk of bleeding. Platelet aggregation inhibitors, valproic acid may increase risk of bleeding. May increase toxicity of methotrexate, zidovudine. Ototoxic medications, vancomycin may increase ototoxicity. May decrease effect of probenecid, sulnpyrazone. HERBAL: Avoid cats claw, dong quai, evening primrose, feverfew, garlic, ginger, ginkgo, ginseng, green tea, horse chestnut, red clover (possess antiplatelet activity). FOOD: None known. LAB VALUES: May alter serum AST, ALT, alkaline phosphatase, uric acid; prolongs prothrombin time (PT), bleeding time. May decrease serum cholesterol, potassium, T3, T4.
DRUG:

Initially, 2.4 3.6 g/day in divided doses, then 3.65.4 g/day. CHILDREN: Initially, 6090 mg/kg/ day in divided doses, then 80100 mg/ kg/day.
Platelet Aggregation Inhibitor PO: ADULTS, ELDERLY: 80325 mg/day. Kawasakis Disease PO: CHILDREN: 80100

mg/kg/day in divided doses q6h. After fever resolves, 35 mg/kg once a day.

SIDE EFFECTS
Occasional:

AVAILABILITY (OTC)
162 mg (Halfprin), 325 mg (Bayer), 500 mg (Bayer). Tablets (Chewable [Bayer, St. Joseph]): 81 mg.
Tablets (Enteric-Coated [Bayer, Ecotrin, St. Joseph]): 81 mg, 325 mg, 500 Caplets (Bayer): 81 mg, 325 mg, 500 mg. Suppositories: 300 mg, 600 mg. Tablets:

GI distress (including abdominal distention, cramping, heartburn, mild nausea); allergic reaction (including bronchospasm, pruritus, urticaria).

ADVERSE EFFECTS/ TOXIC REACTIONS

High doses of aspirin may produce GI bleeding and/or gastric mucosal lesions. Dehydrated, febrile children may ex perience aspirin toxicity quickly. Reyes syndrome may occur in children with chickenpox or u. Low-grade toxicity characterized by tinnitus, generalized pruritus (may be severe), headache, dizziness, ushing, tachycardia, hyperventilation, diaphoresis, thirst. Marked toxicity characterized by hyperthermia, restlessness, seizures, abnormal breathing patterns, respiratory failure, coma.

mg, 650 mg.

ADMINISTRATION/HANDLING
Do not crush or break enteric-coated tablets. May give with water, milk, meals if GI distress occurs.
Rectal PO

Refrigerate suppositories; do not freeze. If suppository is too soft, chill for 30 min in refrigerator or run cold water over foil wrapper. Moisten suppository with cold water before inserting well into rectum.
Canadian trade name

NURSING CONSIDERATIONS
BASELINE ASSESSMENT

Do not give to children or teenagers who have u or chickenpox (increases risk of Reyes syndrome). Do not use if vinegarlike odor is noted (indicates chemical
High Alert drug

Non-Crushable Drug

breakdown). Assess type, location, duration of pain, inammation. Inspect appearance of affected joints for immobility, deformities, skin condition. Therapeutic serum level for antiarthritic effect: 2030 mg/dl (toxicity occurs if level is greater than 30 mg/dl).
INTERVENTION/EVALUATION

Monitor urinary pH (sudden acidication, pH from 6.5 to 5.5, may result in toxicity). Assess skin for evidence of ecchymosis. If given as antipyretic, assess temperature directly before and 1 hr after giving medication. Evaluate for therapeutic response: relief of pain, stiffness, swelling; increased joint mobility; reduced joint tenderness; improved grip strength.
PATIENT/FAMILY TEACHING

Do not crush or chew enteric-coated tablets. Avoid alcohol. Report tinnitus or persistent abdominal GI pain, bleeding. Therapeutic anti-inammatory effect noted in 13 wks. Behavioral changes, vomiting may be early signs of Reyes syndrome. Contact physician.