aspirin/(acetylsalicylic acid, ASA) A

ass-purr-in

(Asaphen E.C.  J, Bayer, Bufferin, Ecotrin, Entaprin, Entrophen  J, Halfprin, Novasen  J, YSP Aspirin, Zero-Order Release, ZORprin)

Do not confuse aspirin or Ascriptin with Aricept, Afrin, or Asendin, or Ecotrin with Edecrin.

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/4.5 mg; 325 mg/2.25 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.

  CLASSIFICATION

PHARMACOTHERAPEUTIC: Nonsteroidal salicylate. CLINICAL: Anti-inflammatory, antipyretic, anticoagulant.

ACTION

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

PHARMACOKINETICS

            Route Onset Peak  Duration      

            PO      1 hr     2U4 hr            4U6 hr           

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: 15U20 min (aspirin); 2U3 hr (salicylate at low dose); more than 20 hr (salicylate at high dose).

USES

Treatment of mild to moderate pain, fever. Reduces inflammation including rheumatoid arthritis, juvenile arthritis, osteoarthritis, rheumatic fever. As platelet aggregation inhibitor in the prevention of transient ischemic attacks (TIAs), cerebral thromboembolism, MI or reinfarction. OFF-LABEL: Acute ischemic stroke, complications of pregnancy (prophylaxis), MI (prophylaxis), prevention of thromboembolism, rheumatic fever, treatment of Kawasaki disease.

PRECAUTIONS

CONTRAINDICATIONS: Allergy to tartrazine dye, bleeding disorders, chickenpox or flu in children and teenagers, GI bleeding or ulceration, hepatic impairment, history of hypersensitivity to aspirin or NSAIDs. CAUTIONS: Vitamin K deficiency, chronic renal insufficiency, those with ‘‘aspirin triad’’ (rhinitis, nasal polyps, asthma).

B 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 full dose used in third trimester of pregnancy). Children: Caution in children with acute febrile illness (Reye’s syndrome). Elderly: May be more susceptible to toxicity; lower dosages recommended.

INTERACTIONS

DRUG: Alcohol, NSAIDs: May increase the risk of adverse GI effects, including ulceration. Antacids, urinary alkalinizers: Increase the excretion of aspirin. Anticoagulants, heparin, thrombolytics: Increase the risk of bleeding. Insulin, oral antidiabetics: May increase the effects of these drugs (with large doses of aspirin). Methotrexate, zidovudine: May increase the risk of toxicity of these drugs. Ototoxic medications, vancomycin: May increase the risk of ototoxicity. Platelet aggregation inhibitors, valproic acid: May increase the risk of bleeding. Probenecid, sulfinpyrazone: May decrease the effects of these drugs. HERBAL: None known. FOOD: None known. LAB VALUES: May alter serum alkaline phosphatase, uric acid, AST, and ALT levels. May prolong PT and bleeding time. May decrease serum cholesterol, serum potassium, and T3 and T4 levels.

AVAILABILITY (OTC)

CAPLETS (BAYER): 81 mg, 325 mg, 500 mg. GELCAPS (BAYER): 325 mg, 500 mg. TABLETS: 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 mg, 650 mg. SUPPOSITORIES: 60 mg, 120 mg, 125 mg, 200 mg, 325 mg, 600 mg, 650 mg.

ADMINISTRATION/HANDLING

PO

N Do not crush or break enteric-coated tablet N May give with water, milk, meals if GI distress occurs.

RECTAL

N Refrigerate suppositories. N If suppository is too soft, chill for 30 min in refrigerator or run cold water over foil wrapper. N Moisten suppository with cold water before inserting well into rectum.

INDICATIONS/ROUTES/DOSAGE

ANALGESIA, FEVER

PO, RECTAL: ADULTS, ELDERLY: 325U1,000 mg q4U6h. CHILDREN: 10U15 mg/kg/dose q4U6h. Maximum: 4 g/day.

ANTI-INFLAMMATORY

PO: ADULTS, ELDERLY: Initially, 2.4U3.6 g/day in divided doses; then 3.6U5.4 g/day. CHILDREN: Initially, 60U90 mg/kg/day in divided doses; then 80U100 mg/kg/day.

PLATELET AGGREGATION INHIBITOR

PO: ADULTS, ELDERLY: 80U325 mg/day.

KAWASAKI DISEASE

PO: CHILDREN: 80U100 mg/kg/day in divided doses.

SIDE EFFECTS

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

ADVERSE REACTIONS/TOXIC EFFECTS

High doses of aspirin may produce GI bleeding and gastric mucosal lesions. Dehydrated, febrile children may experience aspirin toxicity quickly. Reye's syndrome may occur in children with the chickenpox or the flu. Low-grade toxicity characterized is by tinnitus, generalized pruritus (possibly severe), headache, dizziness, flushing, tachycardia, hyperventilation, diaphoresis, and thirst. Marked toxicity is characterized by hyperthermia, restlessness, seizures, abnormal breathing patterns, respiratory failure, and coma.

NURSING CONSIDERATIONS

BASELINE ASSESSMENT

Do not give to children or teenagers who have flu or chickenpox (increases risk of Reye’s syndrome). Do not use if vinegar-like odor is noted (indicates chemical breakdown). Assess type, location, duration of pain, inflammation. Inspect appearance of affected joints for immobility, deformities, skin condition. Therapeutic serum level for anti-arthritic effect: 20U30 mg/dl (toxicity occurs if levels are greater than 30 mg/dl).

INTERVENTION/EVALUATION

Monitor urinary pH (sudden acidification, 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; increase in joint mobility; reduced joint tenderness; improved grip strength.

PATIENT/FAMILY TEACHING

N Do not crush or chew enteric-coated tablets. N Report ringing in ears (tinnitus) or persistent abdominal GI pain. N Therapeutic anti-inflammatory effect noted in 1U3 wk. N Behavioral changes, vomiting may be early signs of Reye’s syndrome. Contact physician.