aspirin

(ass' pir in)

Apo-ASA (CAN), Aspergum, Bayer, Easprin, Ecotrin, Empirin, Entrophen (CAN), Genprin, Halfprin 81, 1/2 Halfprin, Heartline, Norwich, Novasen (CAN), PMS-ASA (CAN), ZORprin

Buffered aspirin products:

Alka-Seltzer, Ascriptin, Asprimox, Bufferin, Buffex, Magnaprin

 

Pregnancy Category D

 

Drug classes

Antipyretic

Analgesic (nonopioid)

Anti-inflammatory

Antirheumatic

Antiplatelet

Salicylate

NSAID

 

Therapeutic actions

Analgesic and antirheumatic effects are attributable to aspirin's ability to inhibit the synthesis of prostaglandins, important mediators of inflammation. Antipyretic effects are not fully understood, but aspirin probably acts in the thermoregulatory center of the hypothalamus to block effects of endogenous pyrogen by inhibiting synthesis of the prostaglandin intermediary. Inhibition of platelet aggregation is attributable to the inhibition of platelet synthesis of thromboxane A2, a potent vasoconstrictor and inducer of platelet aggregation. This effect occurs at low doses and lasts for the life of the platelet (8 days). Higher doses inhibit the synthesis of prostacyclin, a potent vasodilator and inhibitor of platelet aggregation.

 

Indications

        Mild to moderate pain

        Fever

        Inflammatory conditions—rheumatic fever, rheumatoid arthritis, osteoarthritis

        Reduction of risk of recurrent TIAs or stroke in males with history of TIA due to fibrin platelet emboli

        Reduction of risk of death or nonfatal MI in patients with history of infarction or unstable angina pectoris

        MI prophylaxis

        Unlabeled use: Prophylaxis against cataract formation with long-term use

 

Contraindications and cautions

        Contraindicated with allergy to salicylates or NSAIDs (more common with nasal polyps, asthma, chronic urticaria); allergy to tartrazine (cross-sensitivity to aspirin is common); hemophilia, bleeding ulcers, hemorrhagic states, blood coagulation defects, hypoprothrombinemia, vitamin K deficiency (increased risk of bleeding)

        Use cautiously with impaired renal function; chickenpox, influenza (risk of Reye's syndrome in children and teenagers); children with fever accompanied by dehydration; surgery scheduled within 1 wk; pregnancy (maternal anemia, antepartal and postpartal hemorrhage, prolonged gestation, and prolonged labor have been reported; readily crosses the placenta; possibly teratogenic; maternal ingestion of aspirin during late pregnancy has been associated with the following adverse fetal effects: low birth weight, increased intracranial hemorrhage, stillbirths, neonatal death); lactation.

 

Available forms

Tablets—81, 165, 325, 500, 650, 975 mg; SR tablets—650, 800 mg; suppositories—120, 200, 300, 600 mg

 

Dosages

Available in oral and suppository forms. Also available as chewable tablets, gum; enteric coated, sustained-release, and buffered preparations (sustained-release aspirin is not recommended for antipyresis, short-term analgesia, or children < 12 yr.)

ADULTS

        Minor aches and pains: 325–650 mg q 4 hr.

        Arthritis and rheumatic conditions: 3.2–6 g/day in divided doses.

        Acute rheumatic fever: 5–8 g/day; modify to maintain serum salicylate level of 15–30 mg/dL.

        TIAs in men:1,300 mg/day in divided doses (650 mg bid or 325 mg qid).

        MI prophylaxis: 75–325 mg/day.

PEDIATRIC PATIENTS

        Analgesic and antipyretic: 65 mg/kg per 24 hr in four to six divided doses, not to exceed 3.6 g/day. Dosage recommendations by age:

Age (yr)

Dosage

(mg q 4 hr)

2–3

162

4–5

243

6–8

324

9–10

405

11

486

12

648

        Juvenile rheumatoid arthritis: 60–110 mg/kg per 24 hr in divided doses at 4- to 6-hr intervals. Maintain a serum level of 200–300 mcg/mL.

        Acute rheumatic fever: Initially, 100 mg/kg/day, then decrease to 75 mg/kg/day for 4–6 wk. Therapeutic serum salicylate level is 15–30 mg/dL.

        Kawasaki disease: 80–180 mg/kg/day; very high doses may be needed during acute febrile period; after fever resolves, dosage may be adjusted to 10 mg/kg/day.

 

Pharmacokinetics

Route

Onset

Peak

Duration

Oral

5–30 min

15–120 min

3–6 hr

Rectal

1–2 hr

4–5 hr

6–8 hr

 

Metabolism: Hepatic (salicylate); T1/2: 15 min–12 hr

Distribution: Crosses placenta; enters breast milk

Excretion: Urine

 

Adverse effects

        Acute aspirin toxicity: Respiratory alkalosis, hyperpnea, tachypnea, hemorrhage, excitement, confusion, asterixis, pulmonary edema, seizures, tetany, metabolic acidosis, fever, coma, CV collapse, renal and respiratory failure (dose related 20–25 g in adults, 4 g in children)

        Aspirin intolerance: Exacerbation of bronchospasm, rhinitis (with nasal polyps, asthma, rhinitis)

        GI: Nausea, dyspepsia, heartburn, epigastric discomfort, anorexia, hepatotoxicity

        Hematologic: Occult blood loss, hemostatic defects

        Hypersensitivity: Anaphylactoid reactions to anaphylactic shock

        Salicylism: Dizziness, tinnitus, difficulty hearing, nausea, vomiting, diarrhea, mental confusion, lassitude (dose related)

 

Interactions

        Increased risk of bleeding with oral anticoagulants, heparin

        Increased risk of GI ulceration with steroids, phenylbutazone, alcohol, NSAIDs

        Increased serum salicylate levels due to decreased salicylate excretion with urine acidifiers (ammonium chloride, ascorbic acid, methionine)

        Increased risk of salicylate toxicity with carbonic anhydrase inhibitors, furosemide

        Decreased serum salicylate levels with corticosteroids

        Decreased serum salicylate levels due to increased renal excretion of salicylates with acetazolamide, methazolamide, certain antacids, alkalinizers

        Decreased absorption of aspirin with nonabsorbable antacids

        Increased methotrexate levels and toxicity with aspirin

        Increased effects of valproic acid secondary to displacement from plasma protein sites

        Greater glucose lowering effect of sulfonylureas, insulin with large doses (> 2 g/day) of aspirin

        Decreased antihypertensive effect of captopril, beta-adrenergic blockers with salicylates; consider discontinuation of aspirin

        Decreased uricosuric effect of probenecid, sulfinpyrazone

        Possible decreased diuretic effects of spironolactone, furosemide (in patients with compromised renal function)

        Unexpected hypotension may occur with nitroglycerin

        Decreased serum protein bound iodine (PBI) due to competition for binding sites

        False-negative readings for urine glucose by glucose oxidase method and copper reduction method with moderate to large doses of aspirin

        Interference with urine 5-HIAA determinations by fluorescent methods but not by nitrosonaphthol colorimetric method

        Interference with urinary ketone determination by the ferric chloride method

        Falsely elevated urine VMA levels with most tests; a false decrease in VMA using the Pisano method

 

Nursing considerations

Assessment

        History: Allergy to salicylates or NSAIDs; allergy to tartrazine; hemophilia, bleeding ulcers, hemorrhagic states, blood coagulation defects, hypoprothrombinemia, vitamin K deficiency; impaired hepatic function; impaired renal function; chickenpox, influenza; children with fever accompanied by dehydration; surgery scheduled within 1 wk; pregnancy; lactation

        Physical: Skin color, lesions; temperature; eighth cranial nerve function, orientation, reflexes, affect; P, BP, perfusion; R, adventitious sounds; liver evaluation, bowel sounds; CBC, clotting times, urinalysis, stool guaiac, renal and liver function tests

 

Interventions

        Give drug with food or after meals if GI upset occurs.

        Give drug with full glass of water to reduce risk of tablet or capsule lodging in the esophagus.

        Do not crush, and ensure that patient does not chew sustained-release preparations.

        Do not use aspirin that has a strong vinegar-like odor.

        WARNING: Institute emergency procedures if overdose occurs: gastric lavage, induction of emesis, activated charcoal, supportive therapy.

 

Teaching points

        Take extra precautions to keep this drug out of the reach of children; this drug can be very dangerous for children.

        Use the drug only as suggested; avoid overdose. Avoid the use of other OTC drugs while taking this drug. Many of these drugs contain aspirin, and serious overdose can occur.

        Take the drug with food or after meals if GI upset occurs.

        Do not cut, crush, or chew SR products.

        OTC aspirins are equivalent. Price does not reflect effectiveness.

        You may experience these side effects: Nausea, GI upset, heartburn (take drug with food); easy bruising, gum bleeding (related to aspirin's effects on blood clotting).

        Report ringing in the ears; dizziness, confusion; abdominal pain; rapid or difficult breathing; nausea, vomiting.

 

Adverse effects in Italic are most common; those in Bold are life-threatening.