P - Contraindicated in pregnancy
L - Contraindicated in lactation
FI - Food*
LI - l
Aspirin (USAN), also known as acetylsalicylic acid is a salicylate drug, often used as an analgesic to relieve minor aches and pains, as an antipyretic to reduce fever, and as an anti-inflammatory medication.
Aspirin also has an antiplatelet effect by inhibiting the production of thromboxane, which under normal circumstances binds platelet molecules together to repair damaged blood vessels. This is why aspirin is used in long-term, low doses to prevent heart attacks, strokes, and blood clot formation in people at high risk for developing blood clots. It has also been established that low doses of aspirin may be given immediately after a heart attack to reduce the risk of another heart attack or of the death of cardiac tissue.
The main undesirable side effects of aspirin are gastrointestinal ulcers, stomach bleeding, and tinnitus, especially in higher doses. In children and adolescents, aspirin is no longer used to control flu-like symptoms or the symptoms of chickenpox or other viral illnesses, because of the risk of Reye's syndrome.
Aspirin was the first discovered member of the class of drugs known as non-steroidal anti-inflammatory drugs (NSAIDs), not all of which are salicylates, although they all have similar effects and most have inhibition of the enzyme cyclooxygenase as their mechanism of action. Today, 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).
Aspirin is an analgesic, anti-inflammatory and antipyretic. It inhibits cyclooxygenase, which is responsible for the synthesis of prostaglandin and thromboxane. It also inhibits platelet aggregation.
Duration: 4-6 hr.
Absorption: Rapidly absorbed from the GI tract (oral); less reliable (rectal); absorbed through the skin (topical). Peak plasma concentrations after 1-2 hr.
Distribution: Widely distributed; crosses the placenta; enters breast milk. Protein-binding: 80-90%.
Metabolism: Hepatic; converted to metabolites.
Excretion: Via urine by glomerular filtration, active renal tubular secretion and passive tubular reabsorption (as unchanged drug); via haemodialysis; 15-20 minutes (elimination half-life, parent drug).
As analgesic, anti inflammatory, and prophylaxis of myocardial infarction
GI disturbances; prolonged bleeding time, rhinitis, urticaria and epigastric discomfort; angioedema, salicylism, tinnitus; bronchospasm.
Potentially Fatal: Gastric erosion, ulceration and bleeding; severe, occasionally fatal exacerbation of airway obstruction in asthma; Reye's syndrome (children <12 yr). Hepatotoxicity; CNS depression which may lead to coma; CV collapse and resp failure; paroxysmal bronchospasm and dyspnoea.
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History of peptic ulcer or those prone to dyspepsia and those with gastric mucosal lesion, asthma or allergic disorders, dehydrated patients, uncontrolled hypertension, impaired renal or hepatic function, elderly.
Alcohol, corticosteroids, analgin, phenylbutazone and oxyphenbutazone may increase risk of GI ulceration. Aspirin increases phenytoin levels. May antagonize actions of uricosurics and spironolactone.
Potentially Fatal: May potentiate effects of anticoagulants, methotrexate and oral hypoglycaemics.
Food: Vitamin-rich foods increase urinary excretion
Prophylaxis of myocardial infarction
Adult: 75-325 mg once daily. Lower doses should be used in patients receiving ACE inhibitors.
Adult: 325 mg 2 hr before procedure followed by 160-325 mg/day thereafter.
Oral: Juvenile rheumatoid arthritis
Child: 80-100 mg/kg daily in 5 or 6 divided doses. Up to 130 mg/kg daily in acute exacerbations if necessary.
Mild to moderate pain and fever
Adult: 325-650 mg repeated every 4-6 hr according to response. Max: 4 g/day. May also be given rectally.
Pain and inflammation associated with musculoskeletal and joint disorders
Adult: Initial: 2.4-3.6 g/day in divided doses. Usual maintenance: 3.6-5.4 g/day. Monitor serum concentrations.
Should be taken with food
Contraindicated in pregnancy.
Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.
If full-dose used in 3rd trimester:
Category D: There is positive evidence of human foetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).
Salicylates pass into the breast milk. Although salicylates have not been reported to cause problems in nursing babies, it is possible that problems may occur if large amounts are taken regularly, as for arthritis (rheumatism).
Caffeine passes into the breast milk in small amounts.
Do not give aspirin or other salicylates to a child or a teenager with a fever or other symptoms of a virus infection, especially flu or chickenpox, without first discussing its use with your child's doctor . This is very important because salicylates may cause a serious illness called Reye's syndrome in children and teenagers with fever caused by a virus infection, especially flu or chickenpox.
Some children may need to take aspirin or another salicylate regularly (as for arthritis). However, your child's doctor may want to stop the medicine for a while if a fever or other symptoms of a virus infection occur. Discuss this with your child's doctor, so that you will know ahead of time what to do if your child gets sick.
Children who do not have a virus infection may also be more sensitive to the effects of salicylates, especially if they have a fever or have lost large amounts of body fluid because of vomiting, diarrhea, or sweating. This may increase the chance of side effects during treatment.
Elderly people are especially sensitive to the effects of salicylates. This may increase the chance of side effects during treatment.
Hypersensitivity (attacks of asthma, angioedema, urticaria or rhinitis), active peptic ulceration; pregnancy (3rd trimester), children <12 yr, patients with haemophilia or haemorrhagic disorders, gout, severe renal or hepatic impairment, lactation.
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