Aluminum Hydroxide / Aspirin / Calcium Carbonate / Magnesium Hydroxide Dosage

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Usual Adult Dose for Ankylosing Spondylitis

For treatment of inflammatory diseases such as ankylosing spondylitis, osteoarthritis, rheumatoid arthritis, and SLE-associated arthritis and pleurisy:

Initial: 2.4 to 3.6 g (aspirin) per day orally in equally divided doses.
Maintenance: 3.6 to 5.4 g (aspirin) per day orally in equally divided doses; higher dosages may be necessary in some cases.

Serum salicylate levels may be useful in guiding therapeutic decisions regarding dosage titration. Serum salicylate levels of 150 to 300 mcg/mL are associated with anti-inflammatory response. However, the incidence of toxicity increases with salicylate levels > 200 mcg/mL.

Usual Adult Dose for Osteoarthritis

For treatment of inflammatory diseases such as ankylosing spondylitis, osteoarthritis, rheumatoid arthritis, and SLE-associated arthritis and pleurisy:

Initial: 2.4 to 3.6 g (aspirin) per day orally in equally divided doses.
Maintenance: 3.6 to 5.4 g (aspirin) per day orally in equally divided doses; higher dosages may be necessary in some cases.

Serum salicylate levels may be useful in guiding therapeutic decisions regarding dosage titration. Serum salicylate levels of 150 to 300 mcg/mL are associated with anti-inflammatory response. However, the incidence of toxicity increases with salicylate levels > 200 mcg/mL.

Usual Adult Dose for Rheumatoid Arthritis

For treatment of inflammatory diseases such as ankylosing spondylitis, osteoarthritis, rheumatoid arthritis, and SLE-associated arthritis and pleurisy:

Initial: 2.4 to 3.6 g (aspirin) per day orally in equally divided doses.
Maintenance: 3.6 to 5.4 g (aspirin) per day orally in equally divided doses; higher dosages may be necessary in some cases.

Serum salicylate levels may be useful in guiding therapeutic decisions regarding dosage titration. Serum salicylate levels of 150 to 300 mcg/mL are associated with anti-inflammatory response. However, the incidence of toxicity increases with salicylate levels > 200 mcg/mL.

Usual Adult Dose for Systemic Lupus Erythematosus

For treatment of inflammatory diseases such as ankylosing spondylitis, osteoarthritis, rheumatoid arthritis, and SLE-associated arthritis and pleurisy:

Initial: 2.4 to 3.6 g (aspirin) per day orally in equally divided doses.
Maintenance: 3.6 to 5.4 g (aspirin) per day orally in equally divided doses; higher dosages may be necessary in some cases.

Serum salicylate levels may be useful in guiding therapeutic decisions regarding dosage titration. Serum salicylate levels of 150 to 300 mcg/mL are associated with anti-inflammatory response. However, the incidence of toxicity increases with salicylate levels > 200 mcg/mL.

Usual Adult Dose for Fever

325 to 650 mg (aspirin) orally every 4 hours as needed, not to exceed 4 g/day.

Usual Adult Dose for Pain

325 to 650 mg (aspirin) orally every 4 hours as needed, not to exceed 4 g/day.

Usual Adult Dose for Rheumatic Fever

80 mg/kg (aspirin) per day orally in 4 equally divided doses, up to 6.5 g/day.

Dosage may be adjusted according to patient response, tolerance, and serum salicylate levels (therapeutic range = 250 to 400 mcg/mL for rheumatic fever). Generally after 1 to 2 weeks, the dosage is decreased to approximately 60 to 70 mg/kg/day and given for an additional 1 to 6 weeks or longer if necessary, then gradually withdrawn over 1 to 2 weeks. An appropriate course of antibiotic therapy should be initiated at the time of diagnosis of rheumatic fever.

Usual Adult Dose for Myocardial Infarction

1/2 to 1 regular-strength tablet orally once a day beginning as soon as an acute myocardial infarction is suspected and continuing for 30 days. Long-term aspirin therapy for secondary prevention is recommended after 30 days.

Usual Adult Dose for Ischemic Stroke

1/2 to 1 regular-strength tablet orally once a day beginning within 48 hours of the onset of stroke and continuing for 2 to 4 weeks. Long-term aspirin therapy for secondary prevention is recommended after 2 to 4 weeks.

Usual Adult Dose for Angina Pectoris

1/2 to 1 regular-strength tablet orally once a day beginning as soon as unstable angina is diagnosed and continuing indefinitely.

Usual Adult Dose for Angina Pectoris Prophylaxis

1/2 to 1 regular-strength tablet orally once a day, continued indefinitely.

Usual Adult Dose for Thromboembolic Stroke Prophylaxis

1/2 to 1 regular-strength tablet orally once a day, continued indefinitely.

Usual Adult Dose for Myocardial Infarction - Prophylaxis

1/2 to 1 regular-strength tablet orally once a day, continued indefinitely.

Usual Adult Dose for Ischemic Stroke - Prophylaxis

1/2 to 1 regular-strength tablet orally once a day, continued indefinitely.

Usual Adult Dose for Revascularization Procedures - Prophylaxis

For coronary artery bypass graft (CABG): 1 regular-strength tablet orally once a day beginning 6 hours after the procedure and continuing for 1 year or indefinitely as needed.

For percutaneous transluminal coronary angiography (PTCA): 1 regular-strength tablet orally once 2 hours prior to procedure, then 1/2 to 1 regular-strength tablet orally once a day indefinitely.

For carotid endarterectomy: 1/2 regular-strength tablet orally once a day up to 1 extra-strength tablet or 2 regular-strength tablets orally twice a day beginning prior to surgery and continuing indefinitely.

Usual Pediatric Dose for Fever

2 to 11 years: 10 to 15 mg/kg (aspirin) orally every 4 to 6 hours as needed, not to exceed 4 g/day.

>=12 years: 325 to 650 mg (aspirin) orally every 4 hours as needed, not to exceed 4 g/day.

Usual Pediatric Dose for Pain

2 to 11 years: 10 to 15 mg/kg (aspirin) orally every 4 to 6 hours as needed, not to exceed 4 g/day.

>=12 years: 325 to 650 mg (aspirin) orally every 4 hours as needed, not to exceed 4 g/day.

Usual Pediatric Dose for Juvenile Rheumatoid Arthritis

2 to 11 years or <=25 kg:
Initial: 60 to 90 mg/kg (aspirin) per day orally in equally divided doses.
Maintenance: 80 to 100 mg/kg (aspirin) per day orally in equally divided doses; higher dosages, up to 130 mg/kg/day, may be necessary in some cases, not to exceed 5.4 g/day.

>=12 years or >25 kg:
Initial: 2.4 to 3.6 g (aspirin) per day orally in equally divided doses.
Maintenance: 3.6 to 5.4 g (aspirin) per day orally in equally divided doses; higher dosages may be necessary in some cases.

Serum salicylate levels may be useful in guiding therapeutic decisions regarding dosage titration. Serum salicylate levels of 150 to 300 mcg/mL are associated with anti-inflammatory response. However, the incidence of toxicity increases with salicylate levels > 200 mcg/mL.

Usual Pediatric Dose for Kawasaki Disease

Initial (acute febrile period): 80 to 100 mg/kg (aspirin) per day orally in 4 equally divided doses every 4 to 6 hours.

Maintenance (post-febrile period): 3 to 5 mg/kg (aspirin) orally once daily. Patients without coronary artery abnormalities should continue low-dose aspirin for 6 to 8 weeks or until ESR and platelet count are normal. Patients with coronary artery abnormalities should continue low-dose aspirin therapy indefinitely.

Usual Pediatric Dose for Rheumatic Fever

90 to 130 mg/kg (aspirin) per day in equally divided doses every 4 to 6 hours, up to 6.5 mg/day.

Dosage may be adjusted according to patient response, tolerance, and serum salicylate levels (therapeutic range = 250 to 400 mcg/mL for rheumatic fever). Generally after 1 to 2 weeks, the dosage is decreased to approximately 60 to 70 mg/kg/day and given for an additional 1 to 6 weeks or longer if necessary, then gradually withdrawn over 1 to 2 weeks. An appropriate course of antibiotic therapy should be initiated at the time of diagnosis of rheumatic fever.

Usual Pediatric Dose for Prosthetic Heart Valves - Mechanical Valves

6 to 20 mg/kg (aspirin) orally once daily.

Aspirin may be administered in combination with an oral anticoagulant if systemic embolism occurs despite achieving target INR levels, or it may be used with low-dose oral anticoagulant and dipyridamole when full-dose warfarin is contraindicated.

Renal Dose Adjustments

Aspirin should be used with caution in chronic renal insufficiency, since it may cause a transient decrease in renal function. The use of aspirin in patients with severe renal impairment (CrCl <10 mL/minute) is not recommended due to the potential for increased risk of salicylate toxicity.

Liver Dose Adjustments

The use of aspirin in patients with severe hepatic impairment is not recommended due to the potential for increased risk of clinically significant bleeding and other adverse effects.

Precautions

Aspirin should not be used in children or adolescents with chickenpox or influenza symptoms due to the association with Reye's syndrome.

Dialysis

Detailed information concerning the pharmacokinetic disposition of aspirin in patients with renal dysfunction or the removal of aspirin by hemodialysis is not available. Some investigators have suggested that aspirin and/or salicylate may be removed by hemodialysis and that aspirin dosing should follow dialysis sessions.

Other Comments

Aspirin should be administered with food or after meals.

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