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Class: Salicylates
VA Class: CN103
CAS Number: 50-78-2
Brands: Aggrenox, Alka-Seltzer, Anacin, Ascriptin, Ascomp, Aspergum, Bayer, BC Powder, Bufferin, Cope, Easprin, Ecotrin, Endodan, Equagesic, Fiorinal, Fortabs, Gelpirin, Genacote, Goody’s, Halfprin, Lanorinal, Micrainin, Norgesic, Percodan, Soma Compound, St. Joseph, Stanback Powder, Synalgos-DC, Vanquish, ZORprin

Introduction

NSAIA; salicylate ester of acetic acid.a

Uses for Aspirin

Pain

Symptomatic relief of mild to moderate pain.a

Self-medication in children for the temporary relief of minor aches and pains and headache.841

Self-medication in adolescents and adults for the temporary relief of minor aches and pains associated with headache, common cold, toothache, muscular aches, backache, arthritis, menstrual cramps,836 and sore throat.837 840

Self-medication in fixed combination with acetaminophen and caffeine for the temporary relief of mild to moderate pain associated with migraine headache;701 702 703 also can be used for the treatment of severe migraine headache if previous attacks have responded to similar non-opiate analgesics or NSAIAs.701 702 703 778

Fever

Self-medication for reduction of fever associated with colds, sore throats, and teething.837 841 (See Contraindications and see Pediatric Use under Cautions.)

Inflammatory Diseases

Symptomatic treatment of rheumatoid arthritis, juvenile rheumatoid arthritis, osteoarthritis, spondyloarthropathies, and systemic lupus erythematosus (SLE).a c l m

Rheumatic Fever

Symptomatic treatment of rheumatic fever.a A drug of choice in patients with mild carditis (without cardiomegaly or CHF, with or without polyarthritis) or with polyarthritis only.h

Transient Ischemic Attacks and Ischemic Stroke

Reduction of the risk of recurrent TIAs or stroke or of death in patients with a history of TIAs or ischemic stroke (secondary prevention).646 682 842 1009 c m

Also used in fixed combination with extended-release dipyridamole to reduce the risk of recurrent stroke, death from all vascular causes, or nonfatal MI in patients who have had TIAs or completed ischemic stroke caused by thrombosis.716 738 739 743 1009

The American College of Chest Physicians (ACCP), the American Stroke Association (ASA), and AHA consider aspirin or the combination of aspirin and extended-release dipyridamole acceptable antiplatelet regimens for secondary prevention of noncardioembolic ischemic stroke and TIAs; other options include cilostazol or clopidogrel.990 1009 When selecting an appropriate antiplatelet regimen, consider factors such as the patient's individual risk for recurrent stroke, tolerance, and cost of the different agents.990

Oral anticoagulation (e.g., dabigatran, warfarin) rather than antiplatelet therapy is recommended in patients with a history of ischemic stroke or TIA and concurrent atrial fibrillation; however, in patients who cannot take or choose not to take oral anticoagulants (e.g., those with difficulty maintaining stable INRs, compliance issues, dietary restrictions, or cost limitations), dual antiplatelet therapy with aspirin and clopidogrel is recommended.1009

Also used for acute treatment of ischemic stroke in children.1013

Secondary Prevention of Coronary Artery Disease and Myocardial Infarction

Recommended by AHA and the American College of Cardiology Foundation (ACCF) for reduction of the risk of vascular events (e.g., stroke, recurrent MI) in all patients with CAD, unless contraindicated.992

Reduction of the risk of vascular mortality in patients with suspected acute ST-segment-elevation MI (STEMI).579 635 636 646 821 c m

Reduction of the risk of stroke and recurrent infarction in patients surviving an MI (secondary prevention).579 635 646 821 842 1010 c m

Recommended by American Diabetes Association (ADA) for the prevention of cardiovascular events in diabetic patients who have evidence of large-vessel disease (e.g., history of MI, CABG, stroke or TIA, peripheral vascular disease, claudication, angina). 830 901

Use in conjunction with a P2Y12 platelet adenosine diphosphate (ADP)-receptor antagonist (e.g., clopidogrel, prasugrel, ticagrelor) following an acute coronary syndrome (ACS), including STEMI.992 993 994 1010

The addition of warfarin to antiplatelet therapy is recommended in patients with MI who have indications for anticoagulation (e.g., atrial fibrillation, left ventricular dysfunction, cerebral emboli, extensive wall-motion abnormality, mechanical heart valves).993 996 1007 1010

Slideshow: View Frightful (But Dead Serious) Drug Side Effects

Primary Prevention of Ischemic Cardiac Events

May reduce the risk of a first cardiac event (e.g., MI) in certain patient populations (primary prevention).573 574 575 576 658 659 660 661 666 667 668 670 671 783 785 786 848 851 Balance of risks and benefits is most favorable in patients at moderate to high risk of CHD783 (based on age and 10-year risk of cardiac event >10%).668 832 Use of aspirin in such patients is suggested over either warfarin or no antithrombotic therapy.

Recommended by ADA for primary prevention in patients with type 1 or type 2 diabetes mellitus who are at high risk for cardiovascular events (i.e., familial history of CHD, smoking, hypertension, obesity, albuminuria, elevated blood cholesterol or triglyceride concentrations) and in whom aspirin is not contraindicated.760 830 901

Benefit appears to be minimal or lacking in women at low risk for CHD, except possibly those ≥65 years of age; further study needed.846 847 848 849 850 851

Not currently recommended for primary prevention in the general population without known risk factors.646 658 661 674 675 676 783 784 847

ACCP suggests primary prevention with low-dose aspirin in individuals ≥50 years of age who do not have symptomatic cardiovascular disease.1010

Unstable Angina or Non-ST-Segment-Elevation Myocardial Infarction

Reduction of the risk of death and/or nonfatal MI in patients with unstable angina or non-ST-segment-elevation MI (NSTEMI).c 581 613 614 615 616 617 618 619 620 621 682 684 728 736 m

Dual-drug antiplatelet therapy with aspirin and a P2Y12-receptor antagonist (e.g., clopidogrel, prasugrel, ticagrelor) is considered part of the current standard of care for treatment and secondary prevention in patients with ACS.992 993 994 1010

Chronic Stable Angina

Reduction of the risk of MI and/or sudden death in patients with chronic stable angina.c 646 680 728 736 822 m

Percutaneous Coronary Intervention and Revascularization Procedures

Reduction of cardiovascular risks (e.g., early ischemic complications, graft closure) in patients with ACS undergoing PCI (e.g., coronary angioplasty, stent implantation)646 866 887 888 889 992 993 994 1010 or CABG.646 683 687 781 782

Pretreatment with aspirin prior to PCI recommended by ACCF, AHA, and the Society for Cardiovascular Angiography and Interventions (SCAI).994 Adjunctive therapy with a P2Y12-receptor antagonist (e.g., clopidogrel, prasugrel, ticagrelor) also recommended in patients undergoing PCI with stent placement.994

Continue low-dose aspirin therapy indefinitely as secondary prevention against cardiovascular events following PCI.993 994 1010

Embolism Associated with Atrial Fibrillation/Flutter

Used as an alternative or adjunct to warfarin therapy for reduction of the incidence of thromboembolism in selected patients with chronic atrial fibrillation or atrial flutter.749 880 999 1007

ACCP, ACC, AHA, and other experts currently recommend antithrombotic therapy (e.g., warfarin, aspirin) in patients with persistent, permanent, or paroxysmal atrial fibrillation, unless such therapy is contraindicated.999 1007

Choice of antithrombotic therapy is based on patient's risk for stroke.999 1007 In general, oral anticoagulant therapy is recommended in patients with high risk for stroke, while aspirin is recommended in low-risk patients or those with contraindications to oral anticoagulant therapy.999 1007

In patients with atrial fibrillation at increased risk of stroke who cannot take or choose not to take oral anticoagulants for reasons other than concerns about major bleeding (e.g., those with difficulty maintaining stable INRs), combination therapy with clopidogrel and aspirin rather than aspirin alone is recommended.998 1007

Peripheral Arterial Disease

Has been used for primary and secondary prophylaxis of cardiovascular events in patients with peripheral arterial disease, including those with intermittent claudication or carotid stenosis and those undergoing revascularization procedures (peripheral artery percutaneous transluminal angioplasty or peripheral arterial bypass graft surgery).1011

ACCP suggests the use of low-dose aspirin for primary prevention in patients with asymptomatic peripheral arterial disease.1011

For patients with symptomatic peripheral arterial disease or those undergoing revascularization procedures, single-drug antiplatelet therapy with aspirin or clopidogrel generally is recommended.1011

Valvular Heart Disease

Recommended by ACC and AHA for use in selected patients with mitral valve prolapse and atrial fibrillation, and also in symptomatic patients with mitral valve prolapse who experience TIAs.996

Prosthetic Heart Valves

Used for the prevention of thromboembolism in selected patients with prosthetic heart valves.996 1008

ACCP and ACC/AHA suggest the use of low-dose aspirin for initial (i.e., first 3 months after valve insertion) and long-term antithrombotic therapy in patients with a bioprosthetic heart valve in the aortic position who are in sinus rhythm and have no other indications for warfarin.996 1008 Aspirin also may be considered after initial (3 months) warfarin therapy in patients with a bioprosthetic heart valve in the mitral position who are in sinus rhythm.1008

Addition of an antiplatelet agent such as low-dose aspirin to warfarin therapy recommended in all patients with mechanical heart valves who are at low risk of bleeding.996 1008 Combination therapy with aspirin and warfarin also recommended in patients with bioprosthetic heart valves who have additional risk factors for thrombosis (e.g., atrial fibrillation, previous thromboembolism, left ventricular dysfunction, hypercoagulable condition).996

May be added to therapy with a low molecular weight heparin (LMWH) or heparin (referring throughout this monograph to unfractionated heparin) in pregnant women with prosthetic heart valves who are at high risk for thrombosis.1012

Thrombosis Associated with Fontan Procedure in Children

Has been used for prevention of thromboembolic complications following Fontan procedure (definitive palliative surgical treatment for most congenital univentricular heart lesions) in children.1013

Thromboprophylaxis in Orthopedic Surgery

Has been used for the prevention of venous thromboembolism in patients undergoing major orthopedic surgery (total-hip replacement, total-knee replacement, or hip-fracture surgery).1003 Aspirin generally not considered the drug of choice for this use;1003 however, some evidence suggests some benefit over placebo or no antithrombotic prophylaxis in patients undergoing major orthopedic surgery.953 954 1003

ACCP considers aspirin an acceptable option for pharmacologic thromboprophylaxis in patients undergoing major orthopedic surgery.1003

When selecting an appropriate thromboprophylaxis regimen, consider factors such as relative efficacy and bleeding risk in addition to other logistics and compliance issues.1003

Thromboprophylaxis in General Surgery

Has been used for thromboprophylaxis in patients undergoing general (e.g., abdominal) surgery who are at high risk of venous thromboembolism;1002 however, generally recommended as an alternative to LMWHs and low-dose heparin.1002

Pericarditis

Drug of choice for the management of pain associated with acute pericarditis following MI.635 821

Kawasaki Disease

Treatment of Kawasaki disease; used in conjunction with immune globulin IV (IGIV).636 637 638 1013

Complications of Pregnancy

Has been used alone or in combination with other drugs (e.g., heparin, corticosteroids, immune globulin) for prevention of complications of pregnancy (e.g., preeclampsia, pregnancy loss in women with a history of antiphospholipid syndrome and recurrent fetal loss).594 595 596 597 599 600 601 605 626 627 628 648 650 651 652 653 654 705 706 707 708 709 710 711 712 713 714 715 726 817 857 1012

Low-dose aspirin in combination with sub-Q heparin or an LMWH is recommended by ACCP in women with antiphospholipid antibody (APLA) syndrome and a history of multiple (≥3) pregnancy losses.1012

Routine use of aspirin prophylaxis to reduce the incidence and severity of preeclampsia (even in patients at increased risk of preeclampsia) generally not recommended; 634 705 706 707 712 713 715 can consider prophylaxis in women with prior severe or early-onset preeclampsia, chronic hypertension, severe diabetes, or moderate to severe renal disease.815 816 817 In women at high risk for preeclampsia, ACCP recommends low-dose aspirin during pregnancy, starting from the second trimester.1012 (See Pregnancy under Cautions.)

Prevention of Cancer

Limited data (observational studies) suggest that aspirin or other NSAIAs may reduce the risk of various cancers (e.g., colorectal, breast, gastric cancer);864 870 871 872 873 such results generally not confirmed in randomized controlled trials.864 874 875 876

Regular use (e.g., daily) associated with a reduction in the risk of recurrent colorectal adenomas and colorectal cancer in some studies.789 790 791 792 793 794 795 796 797 798 799 800 801 802 803 804 805 806 807 808 809 810 811 812 813 814 815 Beneficial effects of NSAIAs in reducing colorectal cancer risk dissipate following discontinuance of such therapy. Preventive therapy with aspirin currently not recommended because aspirin does not completely eliminate adenomas; aspirin therapy should not be considered a replacement for colorectal cancer screening and surveillance.790 793 794 795 796 814

Aspirin Dosage and Administration

Administration

Administer orally; may administer rectally as suppositories in patients who cannot tolerate oral therapy.a

Do not use aspirin preparation if strong vinegar-like odor is present.a

Oral Administration

Usually administer orally with food or a full glass of water (240 mL).a 836 m

Film-coated, extended-release, or enteric-coated may be associated with less GI irritation and/or symptomatic GI disturbances than uncoated tablets.a

Do not use delayed-release or extended-release tablets if rapid response is required.a

Swallow delayed-release and extended-release tablets whole; do not crush or chew.a

Prepare oral solution by dissolving 2 tablets for solution (Alka-Seltzer) in 120 mL of water; ingest the entire solution to ensure adequate dosing.838 843 844

Do not chew aspirin preparations for ≥7 days following tonsillectomy or oral surgery;841 837 do not place preparations directly on tooth or gum surface (possible tissue injury from prolonged contact).a

Rectal Administration

Do not administer aspirin tablets rectally.a

Dosage

When used for pain, fever, or inflammatory diseases, attempt to titrate to the lowest effective dosage.a

When used in anti-inflammatory dosages, development of tinnitus can be used as a sign of elevated plasma salicylate concentrations (except in patients with high-frequency hearing impairment).a

Pediatric Patients

Dosage in children should be guided by body weight or body surface area.a 841

Do not use in children and teenagers with varicella or influenza, unless directed by a clinician.841 (See Contraindications under Cautions.)

Pain
Oral

Children 2–11 years of age: 1.5 g/m2 daily administered in 4–6 divided doses (maximum 2.5 g/m2 daily).a

Dose may be given every 4 hours as necessary (up to 5 times in 24 hours).841

Dosage for Self-medication of Pain in Children <12 Years of Age841

Age

Weight

Oral Dose

<3 years of age

<14.5 kg

Consult clinician

3–<4 years

14.5–16 kg

160 mg

4–<6 years

16–20.5 kg

240 mg

6–<9 years

20.5–30 kg

320 mg

9–<11 years

30–35 kg

320–400 mg

11 years

35–38 kg

320–480 mg

For self-medication in children ≥12 years of age, 325–650 mg every 4 hours (maximum 4 g daily) or 1 g every 6 hours as necessary.836 e

For self-medication in children ≥12 years of age, 454 mg (as chewing gum pieces) every 4 hours as necessary (maximum 3.632 g daily).837

For self-medication in children ≥12 years of age, 650 mg (as highly buffered effervescent solution [Alka-Seltzer Original]) every 4 hours (maximum 2.6 g daily); alternatively, 1 g (Alka-Seltzer Extra Strength) every 6 hours (maximum 3.5 g daily).843 844

Rectal

Children 2–11 years of age: 1.5 g/m2 daily administered in 4–6 divided doses (maximum 2.5 g/m2 daily).a

Children ≥12 years of age: 325–650 mg every 4 hours as necessary (maximum 4 g daily).a

Fever
Oral

Children 2–11 years of age: 1.5 g/m2 daily administered in 4–6 divided doses (maximum 2.5 g/m2 daily).a

Dose may be given every 4 hours as necessary (up to 5 times in 24 hours).841

Dosage for Self-medication of Fever in Children <12 Years of Age841

Age

Weight

Oral Dose

<3 years of age

<14.5 kg

Consult physician

3–<4 years

14.5–16 kg

160 mg

4–<6 years

16–20.5 kg

240 mg

6–<9 years

20.5–30 kg

320 mg

9–<11 years

30–35 kg

320–400 mg

11 years

35–38 kg

320–480 mg

Children ≥12 years of age: 325–650 mg every 4 hours as necessary (maximum 4 g daily).a

For self-medication in children ≥12 years of age, 454 mg (as chewing gum pieces) every 4 hours as necessary (maximum 3.632 g daily).837

Rectal

Children 2–11 years of age: 1.5 g/m2 daily administered in 4–6 divided doses (maximum 2.5 g/m2 daily).a

Children ≥12 years of age: 325–650 mg every 4 hours as necessary (maximum 4 g daily).a

Inflammatory Diseases
Juvenile Rheumatoid Arthritis
Oral

Initially, 90–130 mg/kg daily in divided doses.c m Increase dosage as necessary for anti-inflammatory efficacy; target plasma salicylate concentration is 150–300 mcg/mL.c m Plasma concentrations >200 mcg/mL associated with an increased incidence of toxicity.c m

Rheumatic Fever
Oral

Initially, 90–130 mg/kg daily given in divided doses every 4–6 hours for up to 1–2 weeks for maximal suppression of acute inflammation, followed by 60–70 mg/kg daily in divided doses for 1–6 weeks.a Adjust dosage based on response, tolerance, and plasma salicylate concentrations.a Gradually withdraw over 1–2 weeks.a

Various regimens suggested depending on severity of initial manifestations.a Consult published protocols for more information on specific dosages and schedules.a

Thrombosis
Acute Arterial Ischemic Stroke
Oral

ACCP recommends 1–5 mg/kg daily initially until cerebral arterial dissection and cardioembolic causes have been excluded; subsequently, continue same dosage for ≥2 years.1013

In children with acute arterial ischemic stroke secondary to non-Moyamoya vasculopathy, at least 3 months of therapy recommended; ongoing antithrombotic therapy should be guided by repeat cerebrovascular imaging.1013

Fontan Procedure
Oral

1–5 mg/kg daily recommended by ACCP; optimal duration of therapy unknown.1013

Prosthetic Heart Valves (Mechanical or Biological)
Oral

ACCP recommends that clinicians follow same recommendations as in adults.1013

Kawasaki Disease
Oral

Initially, 80–100 mg/kg daily given in 4 equally divided doses (in combination with IGIV) for up to 14 days; initiate within 10 days of onset of fever.636 637 638 639 640 1013 When fever subsides, decrease dosage to 1–5 mg/kg once daily.636 637 638 950 1013

Continue indefinitely in those with coronary artery abnormalities;638 950 1013 in the absence of such abnormalities, continue low-dose aspirin for 6–8 weeks.638 950 1013

Adults

Pain
Oral

For self-medication, 325–650 mg every 4 hours (maximum 4 g daily) or 0.5–1 g every 6 hours as necessary.836 e

For self-medication, 454 mg (as chewing gum pieces) every 4 hours as necessary (maximum 3.632 g daily).837

Adults <60 years of age for self-medication: 650 mg (as a highly buffered effervescent solution [Alka-Seltzer Lemon-Lime or Original]) every 4 hours (maximum 2.6 g daily); alternatively, 1 g (Alka-Seltzer Extra Strength) every 6 hours (maximum 3.5 g daily).838 843 844

Adults ≥60 years of age for self-medication: 650 mg (as a highly buffered effervescent solution [Alka-Seltzer Lemon-Lime or Original]) every 4 hours (maximum 1.3 g daily); alternatively, 1 g (Alka-Seltzer Extra Strength) every 6 hours (maximum 1.5 g daily).838 843 844

Rectal

325–650 mg every 4 hours as necessary (maximum 4 g daily).a

Pain Associated with Migraine Headache
Oral

For self-medication, 500 mg (combined with acetaminophen 500 mg and caffeine 130 mg) as a single dose.701

Fever
Oral

325–650 mg every 4 hours as necessary (maximum 4 g daily).a

For self-medication, 454 mg (as chewing gum pieces) every 4 hours as necessary (maximum 3.632 g daily).837

Rectal

325–650 mg every 4 hours as necessary (maximum 4 g daily).a

Inflammatory Diseases
Rheumatoid Arthritis and Arthritis and Pleurisy of SLE
Oral

Initially, 3 g daily in divided doses.c l m Increase dosage as necessary for anti-inflammatory efficacy; target plasma salicylate concentration is 150–300 mcg/mL.c l m Plasma concentrations >200 mcg/mL associated with an increased incidence of toxicity.c l m

Osteoarthritis
Oral

Up to 3 g daily in divided doses.c m

Spondyloarthropathies
Oral

Up to 4 g daily in divided doses.c m

Rheumatic Fever
Oral

Initially, 4.9–7.8 g daily in divided doses given for maximal suppression of acute inflammation.a Adjust dosage based on response, tolerance, and plasma salicylate concentrations.a

Various regimens suggested depending on severity of initial manifestations.a Consult published protocols for more information on specific dosages and schedules.a

Transient Ischemic Attacks and Acute Ischemic Stroke
Secondary Prevention
Oral

50–325 mg daily;a m 646 990 some data suggest lower dosages (75–81 mg daily) may have similar benefits and possibly less bleeding risk.907

In patients with noncardioembolic ischemic stroke or TIA, 75–100 mg daily (or 25 mg twice daily, in combination with extended-release dipyridamole 200 mg twice daily) recommended; continue long term.738 1009

Acute Treatment
Oral

ACCP recommends 160–325 mg daily, initiated ideally within 48 hours of stroke onset; may decrease dosage after 1–2 weeks to reduce bleeding risk. 1009 (See Transient Ischemic Attacks and Acute Ischemic Stroke: Secondary Prevention, under Dosage.)ACCP states that initiation of aspirin therapy should be delayed for 24 hours following administration of recombinant tissue-type plasminogen activator (r-tPA, e.g., alteplase).1009

Coronary Artery Disease and Myocardial Infarction
Acute MI
Oral

160–325 mg as soon as acute MI is suspected (no later than 24 hours after symptom onset), continued daily thereafter at a reduced dosage.c m 579 635 646 821 (See Established Coronary Artery Disease under Dosage and Administration.)

Use in conjunction with a P2Y12-receptor antagonist (e.g., clopidogrel, prasugrel, ticagrelor) following ACS.992 993 994 1010 If used with ticagrelor, do not exceed aspirin maintenance dosage of 100 mg daily; possible reduced efficacy of ticagrelor with such aspirin dosages.955

Rectal

300 mg daily may be considered for patients with severe nausea, vomiting, or upper GI tract disorders.821 862

Primary Prevention of MI
Oral

Some experts recommend 75–162 mg once daily.681 682 760 783 Continue indefinitely, provided there are no contraindications.681 682 760 783

ACCP suggests primary prevention with low-dose aspirin (75–100 mg daily) in individuals ≥50 years of age who do not have symptomatic cardiovascular disease.1010

Established Coronary Artery Disease
Oral

75–100 mg daily recommended by ACCP; continue indefinitely.1010 Some data suggest lower dosages (75–81 mg daily) may have similar benefits and possibly less bleeding risk.907

Unstable Angina and Non-ST-Segment-Elevation Myocardial Infarction
Oral

ACCF and AHA recommend an initial dose of 162–325 mg as soon as possible after diagnosis, unless contraindicated or not tolerated.991 993 Continue with maintenance dosage of 75–162 mg daily.991 1010

Use in conjunction with a P2Y12-receptor antagonist (e.g., clopidogrel, prasugrel, ticagrelor) following ACS.991 992 993 994 1010 If used with ticagrelor, do not exceed aspirin maintenance dosage of 100 mg daily; possible reduced efficacy of ticagrelor with such aspirin dosages.955

Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting Surgery
Oral

PCI in patients already receiving aspirin: 81–325 mg initiated ≥2 hours, and preferably 24 hours, before the procedure in conjunction with a P2Y12-receptor antagonist.994

PCI in patients not already receiving long-term aspirin therapy: 325 mg daily (as nonenteric formulation), initiated ≥2 hours, preferably 24 hours, prior to PCI in conjunction with a P2Y12-receptor antagonist.994

Maintenance therapy following PCI and stent placement (drug-eluting or bare-metal): 75–162 mg daily in combination with a P2Y12-receptor antagonist.992 994 1010 If used with ticagrelor, do not exceed aspirin maintenance dosage of 100 mg daily; possible reduced efficacy of ticagrelor with such aspirin dosages.955 Administer P2Y12-receptor antagonist for ≥12 months; continue aspirin indefinitely.994

CABG: Some manufacturers recommend 325 mg daily, initiated 6 hours after surgery.c m AHA and ACCF recommend 100–325 mg daily, initiated within 6 hours after CABG and continued for up to 1 year.992 For long-term therapy after 1 year, ACCP recommends aspirin 75–100 mg daily.1010

Embolism Associated with Atrial Fibrillation/Flutter
Oral

75–325 mg daily for prevention of thromboembolism.1007

Mitral Valve Prolapse
Oral

75–325 mg daily.996

Peripheral Arterial Disease
Oral

Primary prevention of cardiovascular events in patients with asymptomatic disease: 75–100 mg daily.1011

Secondary prevention of cardiovascular events in patients with symptomatic disease: 75–100 mg daily; continue long term.1011

Patients with refractory intermittent claudication: ACCP suggests the use of cilostazol in addition to aspirin therapy.1011

Peripheral Artery Bypass Graft Surgery
Oral

To reduce graft occlusion: 75–100 mg daily recommended by ACCP; initiate preoperatively and continue long term.1011

ACCP suggests addition of clopidogrel 75 mg daily to aspirin therapy in patients undergoing below-the-knee prosthetic graft bypass surgery.1011

Prosthetic Heart Valves
Mechanical Prosthetic Heart Valves
Oral

Aspirin 50–100 mg daily in addition to warfarin therapy recommended in all patients with a mechanical heart valve who have a low risk of bleeding.996 1008

Aspirin 75–325 mg once daily as monotherapy recommended as an alternative to warfarin in patients who are unable to take warfarin.996

Bioprosthetic Heart Valves
Oral

Patients with bioprosthetic valves in the aortic position: 50–100 mg daily suggested by ACCP for initial (i.e., first 3 months after valve insertion) and long-term therapy.1008

Patients with bioprosthetic heart valves in the mitral position: 50–100 mg daily may be used for long-term antithrombotic therapy after initial 3-month treatment with warfarin.1008

Combination aspirin (75–100 mg daily) and warfarin therapy recommended by ACC/AHA for patients with bioprosthetic heart valves and additional risk factors for thromboembolism.996

Aspirin 75–325 mg once daily also recommended as an alternative to warfarin therapy in any patient who is unable to take warfarin.996

Pericarditis
Acute Pericarditis Following MI
Oral

162–325 mg daily.635 821 Higher dosages (e.g., 650 mg every 4–6 hours) may be required.635 821

Complications of Pregnancy
Oral

Antiphospholipid syndrome and a history of multiple (≥ 3) pregnancy losses: Antepartum prophylaxis with aspirin (75–100 mg daily) in combination with sub-Q heparin or an LMWH recommended by ACCP.1012

Patients at risk for preeclampsia: ACCP recommends low-dose aspirin during pregnancy (starting from the second trimester).1012

Prescribing Limits

Pediatric Patients

Pain
Oral

Children 2–11 years of age: Maximum 2.5 g/m2 daily.a

Children ≥12 years of age: Maximum 4 g daily.836 Maximum 2.6 g as highly buffered effervescent solution (Alka-Seltzer Original) or 3.5 g (Alka-Seltzer Extra Strength) in 24 hours.843 844

For self-medication, do not exceed recommended daily dosage.841 Treatment duration for self-medication for pain: ≤ 5 days.841 (See Advice to Patients.) Treatment duration for self-medication of sore throat pain using chewing gum: ≤2 days.837

Rectal

Children 2–11 years of age: Maximum 2.5 g/m2 daily.a

Children ≥12 years of age: Maximum 4 g daily.a

Fever
Oral

Children 2–11 years of age: Maximum 2.5 g/m2 daily.a

Children ≥12 years of age: Maximum 4 g daily.836

For self-medication, do not exceed recommended daily dosage.841 Treatment duration for self-medication: <3 days.841 (See Advice to Patients.)

Rectal

Children 2–11 years of age: Maximum 2.5 g/m2 daily.a

Children ≥12 years of age: Maximum 4 g daily.a

Adults

Pain
Oral

Maximum 4 g daily.a Treatment duration for self-medication for pain: ≤10 days.841 Aspirin chewing gum should not be used for self-medication of sore throat pain for longer than 2 days.837 (See Advice to Patients.)

Adults <60 years of age taking highly buffered effervescent solutions: Maximum 2.6 g (Alka-SeltzerLemon-lime or Original) or 3.5 g (Alka-Seltzer Extra Strength) in 24 hours.838 843 844

Adults ≥60 years of age taking highly buffered effervescent solutions: Maximum 1.3 g (Alka-SeltzerLemon-lime or Original) or 1.5 g (Alka-Seltzer Extra Strength) in 24 hours.838 843 844

Rectal

Maximum 4 g daily.a

Pain Associated with Migraine Headache
Oral

For self-medication, maximum 500 mg (in combination with acetaminophen 500 mg and caffeine 130 mg) in 24 hours.701

Fever
Oral or Rectal

Maximum 4 g daily.a

Special Populations

Geriatric Patients

Highly buffered effervescent solution: Maximum 1.3 g (Alka-SeltzerLemon-Lime or Original) or 1.5 g (Alka-Seltzer Extra Strength) in 24 hours.838 843 844

Cautions for Aspirin

Contraindications

  • Known hypersensitivity to aspirin or any ingredient in the formulation.c m

  • History of asthma, urticaria, or other sensitivity reaction precipitated by other NSAIAs.c m

  • Syndrome of asthma, rhinitis, and nasal polyps.c

  • Children or adolescents with viral infections (with or without fever) because of the possibility that the infection may be one associated with an increased risk of Reye’s syndrome.c m (See Pediatric Use under Cautions.)

Warnings/Precautions

Warnings

Alcohol

Long-term heavy alcohol use (≥3 alcoholic beverages daily) associated with an increased risk of aspirin-induced bleeding.c j m (See Advice to Patients.)

Hematologic Effects

Inhibits platelet aggregation and may prolong bleeding time.c m These effects may be particularly important in patients with inherited (e.g., hemophilia) or acquired (e.g., liver disease, vitamin K deficiency) bleeding disorders.c m

Because of the increased risk of bleeding, avoid aspirin-containing chewing gum tablets or gargles for ≥1 week after tonsillectomy or oral surgery.h

GI Effects

Serious GI toxicity (e.g., bleeding, ulceration, perforation) can occur with or without warning symptoms.c Increased risk in those with a history of GI bleeding or ulceration, geriatric patients, those receiving an anticoagulant, receiving prolonged therapy, taking multiple NSAIAs concomitantly, and consuming ≥3 alcohol-containing beverages daily.j

Avoid in patients with active peptic ulcer disease; can cause gastric mucosal irritation and bleeding.c m

Thrombosis Associated with Drug-eluting Stents

Stent thrombosis with potentially fatal sequelae, particularly with drug-eluting stents (DES),886 890 891 associated with premature discontinuance (<12 months) of dual-drug therapy with a thienopyridine derivative and aspirin.886 890 891 892 893 894 895 896 897 898 899 900 (See Percutaneous Coronary Intervention and Revascularization Procedures under Uses.) For non-elective procedures that mandate premature discontinuance of thienopyridine-derivative therapy, continue aspirin therapy if at all possible.886 Restart thienopyridine therapy as soon as possible after the procedure.886 (See Advice to Patients.)

Sensitivity Reactions

Anaphylactoid reactions, severe urticaria, angioedema, or bronchospasm reported.836 c h m

Immediate medical intervention and discontinuance for anaphylaxis.836

Contraindicated in patients with syndrome of asthma, rhinitis, and nasal polyps;c m caution in patients with asthma.c

General Precautions

Sodium Content

Avoid highly buffered aspirin preparations in patients with CHF, renal failure, or other conditions in which high sodium content would be harmful.c m

Individuals with Phenylketonuria

Some preparations contain aspartame (NutraSweet), which is metabolized in the GI tract to phenylalanine.a 838

Use of Fixed Combinations

When aspirin is used in fixed combination with other agents, consider the cautions, precautions, and contraindications associated with the other agent(s).a

Specific Populations

Pregnancy

Category C (Category D in third trimester).

Use only if clearly needed.c m Avoid use in the third trimester because of possible premature closure of the ductus arteriosus.c m Avoid 1 week prior to and during labor and delivery; aspirin use prior to and during labor associated with excessive blood loss at delivery.c m

Maternal and fetal hemorrhagic complications observed with maternal ingestion of large doses (e.g., 12–15 g daily) of aspirin594 595 597 611 612 generally have not been observed in studies in which low doses (60–150 mg daily) of the drug were used for prevention of complications of pregnancy.594 595 596 597 598 599 600 601 605 626 627 629 630 631 632

Lactation

Distributed into milk; use not recommended.c m High doses may result in adverse effects (rash, platelet abnormalities, bleeding) in nursing infants.c m

Pediatric Use

Dosing recommendations for juvenile rheumatoid arthritis based on well controlled clinical studies.c m High dosages that result in plasma concentrations >200 mcg/mL associated with an increased incidence of toxicity.c m

Use in children with varicella infection or influenza-like illnesses reportedly is associated with an increased risk of developing Reye’s syndrome.166 167 168 169 468 538 549 638 US Surgeon General, AAP Committee on Infectious Diseases, FDA, and other authorities advise that salicylates not be used in children and teenagers with varicella or influenza, unless directed by a clinician.466 467 554 638 Generally avoid salicylates in children and teenagers with suspected varicella or influenza and during presumed outbreaks of influenza, since accurate diagnosis of these diseases may be impossible during the prodromal period;466 use of salicylates in the management of viral infections in children or adolescents is contraindicated, since the infection may be one associated with an increased risk of Reye’s syndrome.646 m

Use with caution in pediatric patients who are dehydrated (increased susceptibility to salicylate intoxication).h

Safety and efficacy of aspirin in fixed combination with extended-release dipyridamole not established.738

Risk of overdosage and toxicity (including death) in children <2 years of age receiving preparations containing antihistamines, cough suppressants, expectorants, and nasal decongestants alone or in combination for relief of symptoms of upper respiratory tract infection.937 939 Limited evidence of efficacy for these preparations in this age group; appropriate dosages not established.937 Use such preparations in children <2 years of age with caution and only as directed by clinician.937 939 Clinicians should ask caregivers about use of OTC cough/cold preparations to avoid overdosage.937

Hepatic Impairment

Avoid in patients with severe hepatic impairment.c m

Renal Impairment

Avoid in patients with GFR <10 mL/minute.c m

Common Adverse Effects

Minor upper GI symptoms (dyspepsia).c

Interactions for Aspirin

Protein-bound Drugs

Potential for salicylate to be displaced from binding sites by, or to displace from binding sites, other protein-bound drugs.h m Aspirin acetylates serum albumin, which may alter binding of other drugs to the protein.a

Specific Drugs

Drug

Interaction

Comments

ACE inhibitors

Reduced BP response to ACE inhibitorsc

Possible attenuation of hemodynamic actions of ACE inhibitors in patients with CHFh

Reduced hyponatremic effect of ACE inhibitorsc m

Monitor BPc

Acidifying agents

Drugs that decrease urine pH may decrease salicylate excretionh

Alcohol

Increased risk of bleedingc m (see Advice to Patients)

Alkalinizing agents

Drugs that increase urine pH may increase salicylate excretionh

Monitor plasma salicylate concentrations in patients receiving high-dose aspirin therapy if antacids are initiated or discontinuedh

Anticoagulants (warfarin, heparin)

Increased risk of bleedingc m

May displace warfarin from protein-binding sites, leading to prolongation of PT and bleeding timec m

Use with cautionh

Anticonvulsants

May displace phenytoin from binding sites; possible decrease in total plasma phenytoin concentrations, with increased free fractionc m

May displace valproic acid from binding sites; possible increase in free plasma valproic acid concentrations;c h m possible increased risk of bleedingh

Monitor patients receiving aspirin with valproic acidh

Antidiabetic drugs (sulfonylureas)

Potential for increased hypoglycemic effectc m

Monitor closelyh

β-adrenergic blocking agents

Reduced BP response to β-adrenergic blocking agents c m

Potential for salt and fluid retentionm

Monitor BPc

Carbonic anhydrase inhibitors (acetazolamide)

Increased risk of salicylate toxicityh

Increased plasma acetazolamide concentrations; increased risk of acetazolamide toxicityc m

Avoid concomitant use in patients receiving high-dose aspirinh

Corticosteroids

Decreased plasma salicylate concentrationsh

Monitor for adverse effects of either drugh

Diuretics

Possible reduced natriuretic effectc

Methotrexate

Increased plasma methotrexate concentrationsh

Inhibition of renal clearance of methotrexate leading to bone marrow toxicity, especially in geriatric patients or patients with renal impairmentm

Monitor for methotrexate toxicityh

NSAIAs

Increased risk of bleeding, GI ulceration, decreased renal function, or other complications861 m p q r

No consistent evidence that low-dose aspirin mitigates increased risk of serious cardiovascular events associated with NSAIAs861 r

Pharmacokinetic interactions with many NSAIAsh

Antagonism (ibuprofen, naproxen) of the irreversible platelet-aggregation inhibitory effect of aspirin; may limit the cardioprotective effects of aspirin788 858 859 860

Minimal risk of attenuating effects of low-dose aspirin with occasional use of ibuprofen858

Not known whether ketoprofen interferes with the antiplatelet effect of aspirin858 859

Decreased peak plasma concentration and AUC of diclofenac;p q limited data indicate that diclofenac does not inhibit antiplatelet effect of aspirin788

Concomitant use not recommendedc m p q r

Pharmacokinetic interactions unlikely to be clinically importanth

Immediate-release aspirin: Administer a single dose of ibuprofen 400 mg for self-medication≥8 hours before or ≥30 minutes after administration of aspirin858 859

Enteric-coated low-dose aspirin: No recommendations regarding timing of administration with single dose of ibuprofen858 859

Consider use of alternative analgesics that do not interfere with antiplatelet effect of low-dose aspirin (e.g., acetaminophen, opiates) for patients at high risk of cardiovascular events858 859

Concomitant use with prescription NSAIAs not recommended because of potential for increased adverse effects861

Pyrazinamide

Possible prevention or reduction of hyperuricemia associated with pyrazinamideh

Tetracycline

Decreased oral absorption of tetracyclines when administered with aspirin preparations containing divalent or trivalent cations (Bufferin)h

Administer preparations containing divalent or trivalent cations (Bufferin) 1 hr before or after tetracyclineh

Thrombolytic agents

Additive reduction in mortality reported in patients with AMI receiving aspirin in low dosages and thrombolytic agents (streptokinase, alteplase)579 580 581 582 583 584 585 586 587 588 589 590

Used for therapeutic effect579 580 581 582 583 584 585 586 587 588 589 590

Uricosuric agents (probenecid, sulfinpyrazone)

Reduced uricosuric effect of uricosuric agentsc m

Varicella virus vaccine live

Theoretical possibility of Reye’s syndrome638

Manufacturer of varicella virus vaccine live recommends that individuals who receive the vaccine avoid use of salicylates for 6 weeks following vaccination756

For children who are receiving long-term salicylate therapy, AAP suggests weighing theoretical risks of vaccination against known risks of wild-type virus;638 ACIP states that children who have rheumatoid arthritis or other conditions requiring therapeutic salicylate therapy probably should receive varicella virus vaccine live in conjunction with subsequent close monitoring757

Aspirin Pharmacokinetics

Absorption

Bioavailability

Well absorbed following oral administration.h m Rapidly metabolized to salicylic acid; plasma aspirin concentrations are undetectable 1–2 hours after administration.m Peak plasma salicylic acid concentrations attained within 1–2 hours following administration of uncoated tablets.m

Slowly and variably absorbed following rectal administration.h

Onset

Single oral doses of rapidly absorbed preparations: 30 minutes for analgesic and antipyretic effects.h

Rectal suppositories: 1–2 hours for antipyretic effects.h

Continuous oral therapy: 1–4 days for anti-inflammatory effect.h

Food

Food decreases rate but not extent of absorption; peak plasma concentrations of aspirin and salicylate may be decreased.h

Plasma Concentrations

Plasma salicylate concentrations of 30–100 mcg/mL produce analgesia and antipyresis; the concentration required for anti-inflammatory effect is 150–300 mcg/mL; toxicity noted at 300–350 mcg/mL.h

Steady-state plasma salicylate concentrations increase more than proportionally with increasing doses as a result of capacity-limiting processes.h

Special Populations

During the febrile phase of Kawasaki disease, oral absorption may be impaired or highly variable.h

Distribution

Extent

Widely distributed; aspirin and salicylate distribute into synovial fluid.a h m Crosses placenta and distributed into milk.m

Plasma Protein Binding

Aspirin: 33%.a

Salicylate: 90–95% bound at plasma salicylate concentrations <100 mcg/mL; 70–85% bound at concentrations of 100–400 mcg/mL; 25–60% bound at concentrations >400 mcg/mL.h m

Elimination

Metabolism

Partially hydrolyzed to salicylate by esterases in the GI mucosa.a Unhydrolyzed aspirin subsequently undergoes hydrolysis by esterases mainly in the liver but also in plasma, erythrocytes, and synovial fluid.a

Salicylate is metabolized in the liver by the microsomal enzyme system.h

Elimination Route

Excreted in urine via glomerular filtration and renal tubular reabsorption as salicylate and its metabolites.h Urinary excretion of salicylate is pH dependent; as urine pH increases from 5 to 8, urinary excretion of salicylate is greatly increased.h

Half-life

Aspirin: 15–20 minutes.a

Half-life of salicylate increases with increasing plasma salicylate concentrations.h m

Salicylate: 2–3 hours when aspirin administered in low doses (325 mg).h

Salicylate: 15–30 hours when aspirin administered in higher dosages.h

Special Populations

Salicylate and its metabolites readily removed by hemodialysis and, to a lesser extent, by peritoneal dialysis.h

Stability

Storage

Oral

Capsules

Aspirin in fixed-combination with extended-release dipyridamole: 25°C (may be exposed to 15–30°C).738 Protect from excessive moisture.738

Gum

15–25°C; protect from excessive moisture.837

Tablets

Room temperature (Bayer products, excluding Alka-Seltzer products);839 840 841 842 m avoid high humidity and excessive heat (40°C).840

15–30°C (Easprin).l

20–25°C (Anacin Extra Strength); protect from moisture.836

Protect from excessive heat (Alka-Seltzer products).838 843 844

Rectal

Suppositories

2–15°C.a

Actions

  • Inhibits COX-1 and COX-2 activity.1016

  • Pharmacologic actions similar to those of prototypical NSAIAs; exhibits anti-inflammatory, analgesic, and antipyretic activity.c

  • Irreversibly acetylates and inactivates COX-1 in platelets.1016

  • The existence of 2 COX isoenzymes with different aspirin sensitivities and extremely different recovery rates of their COX activity following inactivation by aspirin at least partially explains the different dosage requirements and durations of aspirin effects on platelet function versus the drug’s analgesic and anti-inflammatory effects.1016

  • Effects on urinary excretion of uric acid are dose related; large dosages (e.g., 1.3 g 4 times daily) enhance urinary excretion and decrease serum concentrations of uric acid , intermediate dosages (e.g., 650 mg to 1 g 3 times daily) usually do not alter uric acid excretion, and low dosages (e.g., <325 mg 3 times daily) inhibit excretion and may increase serum uric acid concentrations.h

Advice to Patients

  • When used for self-medication, importance of reading the product labeling.836 841 e 837 838 843 844

  • When used for self-medication, importance of asking clinician whether to use aspirin or another analgesic if alcohol consumption is ≥3 alcohol-containing drinks per day.836 e 837 838 841 843 844

  • Importance of informing patients about risk of bleeding associated with chronic, heavy alcohol use while taking aspirin.j m

  • When used for self-medication in children, importance of basing the dose on the child’s weight or body surface area.841

  • In patients with drug-eluting stents (DES) receiving aspirin in combination with clopidogrel or ticlopidine, importance of not discontinuing antiplatelet therapy without consulting cardiologist, even if instructed to do so by other health-care professional (e.g., dentist).886

  • Importance of not using aspirin for chicken pox or flu symptoms in children or adolescents without consulting a clinician.836 e 837 838 841 843 844

  • Patients receiving anticoagulants and those with asthma, gout, diabetes, arthritis, peptic ulcers, bleeding problems, or stomach problems that persist or recur should consult a clinician before using aspirin for self-medication.836 e 837 838 841 843 844

  • Discontinue and consult clinician if pain or fever persists or progresses, new symptoms occur, redness or swelling is present in a painful area, or ringing in the ears or loss of hearing occurs.836 e 837 838 841 843 844

  • Risk of GI bleeding or ulceration, particularly with prolonged therapy,c j m and concomitant therapy with another NSAIA.j

  • Risk of anaphylactoid and other sensitivity reactions.c

  • Importance of notifying clinician if signs and symptoms of GI ulceration or bleeding or rash develop.c

  • Importance of seeking immediate medical attention if an anaphylactic reaction occurs.c

  • Importance of women informing clinicians if they are or plan to become pregnant or to breast-feed.c Importance of avoiding aspirin in late pregnancy (third trimester) and during labor and delivery.c

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs.c

  • Importance of informing patients of other important precautionary information.c (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Aspirin

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Pieces, chewing gum

227 mg

Aspergum

Heritage, Schering-Plough

Tablets

81 mg*

Aspirin Tablets

325 mg*

Aspirin Tablets

Norwich Aspirin

Chattem

500 mg*

Aspirin Tablets

Norwich Aspirin Maximum Strength

Chattem

650 mg*

Aspirin Tablets

Tablets, chewable

81 mg*

Aspirin Chewable Tablets

Bayer Aspirin Children’s

Bayer

St. Joseph Aspirin Low Strength Adult Chewable

McNeil

Tablets, delayed-release (enteric-coated)

81 mg*

Aspirin Delayed-release (Enteric-coated) Tablets

Bayer Aspirin Regimen Adult Low Strength

Bayer

Ecotrin Adult Low Strength

GlaxoSmithKline

Halfprin

Kramer

St. Joseph Pain Reliever Adult

McNeil

162 mg

Halfprin

Kramer

325 mg*

Aspirin Delayed-release (Enteric-coated) Tablets

Bayer Aspirin Regimen Regular Strength Caplets

Bayer

Ecotrin Regular Strength

GlaxoSmithKline

Genacote

Ivax

500 mg*

Aspirin Delayed-release (Enteric-coated) Tablets

Ecotrin Maximum Strength

GlaxoSmithKline

650 mg*

Aspirin Delayed-release (Enteric-coated) Tablets

975 mg*

Aspirin Delayed-release (Enteric-coated) Tablets

Easprin

Rosedale

Tablets, extended-release

800 mg

ZORprin

Par

Tablets, film-coated

325 mg*

Aspirin Tablets

Genuine Bayer Aspirin Tablets

Bayer

500 mg

Bayer Extra Strength Aspirin Caplets

Bayer

Rectal

Suppositories

60 mg*

Aspirin Suppositories

120 mg*

Aspirin Suppositories

200 mg*

Aspirin Suppositories

300 mg*

Aspirin Suppositories

600 mg*

Aspirin Suppositories

Aspirin with Buffers

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets, enteric-coated

325 mg with buffers

Ascriptin Enteric Regular Strength

Novartis

Tablets, film-coated

81 mg with buffers

Women’s Bayer Aspirin Plus Calcium Caplets

Bayer

325 mg with buffers

Ascriptin Arthritis Pain Caplets

Novartis

Ascriptin Regular Strength

Novartis

Bufferin Tablets

Novartis

500 mg with buffers

Ascriptin Maximum Strength Caplets

Novartis

Bayer Plus Extra Strength Caplets

Bayer

Bufferin Extra Strength Caplets

Novartis

Bufferin Extra Strength

Novartis

Tablets, for solution

325 mg

Alka-Seltzer Effervescent Pain Reliever and Antacid

Bayer

Alka-Seltzer Lemon Lime Effervescent Pain Reliever and Antacid

Bayer

500 mg

Alka-Seltzer Extra Strength Effervescent Pain Reliever and Antacid

Bayer

Acetaminophen and Aspirin

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

For solution

325 mg/packet Acetaminophen and Aspirin 500 mg/packet

Goody’s Body Pain Formula Powders

GlaxoSmithKline

Acetaminophen, Aspirin, and Caffeine

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

For solution

260 mg/packet Acetaminophen, Aspirin 520 mg/packet, and Caffeine 32.5 mg/packet

Goody’s Extra Strength Headache Powders

GlaxoSmithKline

Tablets

125 mg Acetaminophen, Aspirin 240 mg, Caffeine 32 mg, and buffers

Gelpirin

Alra

130 mg Acetaminophen, Aspirin 260 mg, and Caffeine 16.25 mg

Goody’sTablets

GlaxoSmithKline

194 mg Acetaminophen, Aspirin 227 mg, Caffeine 33 mg, and buffers

Vanquish Caplets

Bayer

Tablets, film-coated

250 mg Acetaminophen, Aspirin 250 mg, and Caffeine 65 mg

Excedrin Extra-Strength Caplets

Bristol-Myers

Excedrin Extra-Strength Geltabs

Bristol-Myers

Excedrin Extra-Strength Tablets

Bristol-Myers

Excedrin Migraine Caplets

Bristol-Myers Squibb

Excedrin Migraine Geltabs

Bristol-Myers Squibb

Excedrin Migraine Tablets

Bristol-Myers Squibb

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Oxycodone and Aspirin

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets

2.25 mg Oxycodone Hydrochloride, Oxycodone Terephthalate 0.19 mg, and Aspirin 325 mg*

Percodan-Demi ( C-II; scored)

Endo

4.5 mg Oxycodone Hydrochloride, Oxycodone Terephthalate 0.38 mg, and Aspirin 325 mg*

Endodan ( C-II)

Endo

Percodan ( C-II; scored)

Endo

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Other Aspirin Combinations

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Capsules

325 mg with Butalbital 50 mg and Caffeine 40 mg*

Butalbital, Aspirin, and Caffeine Capsules ( C-III)

Fiorinal ( C-III)

Watson

325 mg with Butalbital 50 mg, Caffeine 40 mg, and Codeine Phosphate 30 mg*

Ascomp with Codeine ( C-III)

Nexgen

Butalbital, Aspirin, Caffeine, and Codeine Phosphate Capsules ( C-III)

Fiorinal with Codeine ( C-III)

Watson

356.4 mg with Caffeine 30 mg and Dihydrocodeine Bitartrate 16 mg

Synalgos-DC ( C-III)

Leitner

Capsules, extended-release core (dipyridamole only)

25 mg with Dipyridamole 200 mg

Aggrenox

Boehringer Ingelheim

For solution

650 mg/packet with Caffeine 33.3 mg/packet and Salicylamide 195 mg/packet

BC Powder

GlaxoSmithKline

650 mg/packet with Caffeine 32 mg/packet and Salicylamide 200 mg/packet

Stanback Powder

GlaxoSmithKline

742 mg/packet with Caffeine 38 mg/packet and Salicylamide 222 mg/packet

BC Powder Arthritis Strength

GlaxoSmithKline

Tablets

325 mg with Butalbital 50 mg and Caffeine 40 mg*

Butalbital, Aspirin, and Caffeine Tablets ( C-III)

Fortabs ( C-III)

United Research

325 mg with Carisoprodol 200 mg*

Carisoprodol and Aspirin Tablets (C-IV)

Soma Compound (C-IV)

Meda

325 mg with Carisoprodol 200 mg and Codeine Phosphate 16 mg*

Carisoprodol, Aspirin, and Codeine Phosphate Tablets ( C-III)

Soma Compound with Codeine (C-III)

Meda

325 mg with Meprobamate 200 mg

Equagesic ( C-IV; scored)

Leitner

Micrainin ( C-IV)

Wallace

385 mg with Caffeine 30 mg and Orphenadrine Citrate 25 mg*

Norgesic

3M

Orphenadrine Citrate, Aspirin, and Caffeine Tablets

Sandoz

400 mg with Caffeine 32 mg

P-A-C Analgesic

Lee

770 mg with Caffeine 60 mg, and Orphenadrine Citrate 50 mg*

Norgesic Forte (scored)

3M

Orphenadrine Citrate, Aspirin, and Caffeine Tablets

Sandoz

Tablets, film-coated

400 mg with Caffeine 32 mg

Anacin Caplets

Wyeth

Anacin Tablets

Wyeth

421 mg with Caffeine 32 mg and buffers

Cope

Lee

500 mg with Caffeine 32 mg

Anacin Maximum Strength

Wyeth

500 mg with Caffeine 32.5 mg

Extra Strength Bayer Back and Body Pain (with propylene glycol)

Bayer

Tablets, for solution

500 mg with Caffeine 65 mg

Alka Seltzer Morning Relief

Bayer

Aspirin is also commercially available in combination with other drugs such as analgesics, antihistamines, antimuscarinics, antitussives, barbiturates, decongestants, and expectorants.

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 09/2014. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

Aggrenox 25-200MG 12-hr Capsules (BOEHRINGER INGELHEIM): 60/$242.99 or 180/$696.98

Aspirin 325MG Tablets (MAJOR PHARMACEUTICALS): 500/$14.99 or 1000/$19.97

Aspirin 325MG Tablets (RUGBY): 100/$11.99 or 200/$13.98

Aspirin 81MG Chewable Tablets (RUGBY): 36/$11.99 or 72/$13.98

Aspirin EC 325MG Enteric-coated Tablets (QUALITEST): 1400/$45.99 or 4200/$135.97

Aspirin EC Low Dose 81MG Enteric-coated Tablets (QUALITEST): 1000/$45.99 or 3000/$129.96

Butalbital-ASA-Caffeine 50-325-40MG Capsules (LANNETT): 30/$32.99 or 90/$95.97

Butalbital-Aspirin-Caffeine 50-325-40MG Tablets (WEST-WARD): 30/$19.99 or 90/$29.97

Carisoprodol-Aspirin 200-325MG Tablets (SANDOZ): 30/$65.99 or 90/$169.96

Carisoprodol-Aspirin-Codeine 200-325-16MG Tablets (SANDOZ): 30/$82.99 or 90/$235.96

Ecotrin 325MG Enteric-coated Tablets (GLAXO CONSUMER HEALTHCARE L.P.): 125/$16.99 or 250/$22.98

Ecotrin Low Strength 81MG Enteric-coated Tablets (GLAXO CONSUMER HEALTHCARE L.P.): 150/$16.99 or 450/$29.97

Fiorinal 50-325-40MG Capsules (WATSON LABS): 100/$228.94 or 200/$440.71

Percodan 4.5-0.38-325MG Tablets (ENDO PHARMACEUTICALS): 20/$39.59 or 30/$52.77

Soma Compound 200-325MG Tablets (MEDA PHARMACEUTICALS): 30/$139.99 or 90/$399.96

AHFS DI Essentials. © Copyright, 2004-2014, Selected Revisions August 28, 2014. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

Only references cited for selected revisions after 1984 are available electronically.

166. Centers for Disease Control. Reye syndrome—Ohio, Michigan. MMWR Morb Mortal Wkly Rep. 1980; 29:532-9.

167. Starko KM, Ray CG, Dominguez LB et al. Reye’s syndrome and salicylate use. Pediatrics. 1980; 66:859-64. [IDIS 129588] [PubMed 7454476]

168. Partin JS, Schubert WK, Partin JC et al. Serum salicylate concentrations in Reye’s disease: a study of 130 biopsy-proven cases. Lancet. 1982; 1:191-4. [IDIS 145169] [PubMed 6119559]

169. Centers for Disease Control. National surveillance for Reye syndrome, 1981—update, Reye syndrome and salicylate usage. MMWR Morb Mortal Wkly Rep. 1982; 31:53-61. [IDIS 143727] [PubMed 6799770]

466. Committee on Infectious Diseases, American Academy of Pediatrics. Aspirin and Reye syndrome. Pediatrics. 1982; 69:810-2. [IDIS 152520] [PubMed 7079050]

467. Centers for Disease Control. Surgeon General’s advisory on the use of salicylates and Reye syndrome. MMWR Morb Mortal Wkly Rep. 1982; 31:289-90. [IDIS 150867] [PubMed 6810083]

468. Waldman RJ, Hall WN, McGee H et al. Aspirin as a risk factor in Reye’s syndrome. JAMA. 1982; 247:3089-04. [IDIS 150801] [PubMed 7077803]

469. Andresen BD, Alexander MS, Ng KJ et al. Aspirin and Reye’s disease: a reinterpretation. Lancet. 1982; 1:903. [IDIS 148861] [PubMed 6122113]

470. Wilson JT, Brown RD. Reye syndrome and aspirin use: the role of prodromal illness severity in the assessment of relative risk. Pediatrics. 1982; 69:822-5. [IDIS 152522] [PubMed 7079054]

529. Daniels SR, Greenberg RS, Ibrahim MA. Scientific uncertainties in the studies of salicylate use and Reye’s syndrome. JAMA. 1983; 249:1311-6. [IDIS 166709] [PubMed 6827709]

537. Remington PL, Rowley D, McGee H et al. Decreasing trends in Reye syndrome and aspirin use in Michigan, 1979 to 1984. Pediatrics. 1986; 77:93-8. [PubMed 3940363]

538. Hurwitz ES, Barrett MJ, Bregman D et al. Public Health Service study on Reye’s syndrome and medications: report of the pilot phase. N Engl J Med. 1985; 313:849-57. [IDIS 204600] [PubMed 4033715]

539. Food and Drug Administration. Labeling for oral and rectal over-the-counter aspirin and aspirin-containing drug products. [21 CFR Part 201] Fed Regist. 1986; 51:8180-2. (IDIS 211617)

549. Hurwitz ES, Barrett MJ, Bregman D et al. Public Health Service study of Reye’s syndrome and medications: report of the main study. JAMA. 1987; 257:1905-11. [IDIS 227218] [PubMed 3820509]

550. Orlowski JP, Gillis J, Kilham HA. A catch in the Reye. Pediatrics. 1987; 80:638-42. [IDIS 237495] [PubMed 3670965]

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p. Novartis. Voltaren-XR (diclofenac sodium extended-release tablets) prescribing information. East Hanover, NJ; 2006 Jan.

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r. Roche. EC-Naprosyn (naproxen) delayed-release tablets, Naprosyn (naproxen) tablets, Anaprox/Anaprox DS (naproxen sodium) tablets, and Naprosyn (naproxen) suspension prescribing information. Nutley, NJ; 2007.

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