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Aspirin (rectal)

Generic Name: aspirin (rectal) (AS pi rin)
Brand Name: Aspirin

What is rectal aspirin?

Aspirin is in a group of drugs called salicylates. It works by reducing substances in the body that cause pain and inflammation. Aspirin also reduces fever.

Rectal aspirin is given as a suppository to reduce pain, inflammation, and fever. Aspirin is also used to treat the symptoms of arthritis and rheumatic fever.

Rectal aspirin may also be used for purposes not listed in this medication guide.

What is the most important information I should know about rectal aspirin?

Rectal aspirin should not be used in a child or teenager who has a fever, especially if the child also has flu symptoms or chicken pox. Aspirin can cause a serious and sometimes fatal condition called Reye's syndrome.

Do not take an aspirin rectal suppository by mouth. It is for use only in your rectum.

This medication comes with patient instructions for using the rectal suppository. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

Try to empty your bowel and bladder just before using the aspirin suppository.

Remove the outer wrapper from the suppository before inserting it. Avoid handling the suppository too long or it will melt in your hands.

What should I discuss with my health care provider before using rectal aspirin?

Do not use this medication if you are allergic to aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Motrin, Advil), celecoxib (Celebrex), diclofenac (Arthrotec, Cambia, Cataflam, Voltaren, Flector Patch, Pennsaid, Solareze), diflunisal (Dolobid), etodolac (Lodine), flurbiprofen (Ansaid), indomethacin (Indocin), ketoprofen (Orudis), ketorolac (Toradol), mefenamic acid (Ponstel), meloxicam (Mobic), nabumetone (Relafen), naproxen (Aleve, Naprosyn, Naprelan, Treximet), piroxicam (Feldene), and others.

Rectal aspirin should not be used in a child or teenager who has a fever, especially if the child also has flu symptoms or chicken pox. Aspirin can cause a serious and sometimes fatal condition called Reye's syndrome.

Ask a doctor or pharmacist if it is safe for you to use this medicine if you have:

  • Kawasaki disease;

  • a bleeding or blood clotting disorder such as hemophilia;

  • glaucoma;

  • a stomach ulcer or bleeding;

  • a weak immune system;

  • asthma or nasal polyps;

  • high blood pressure or heart disease;

  • kidney disease; or

  • liver disease.

Aspirin may be harmful to an unborn baby, and may also cause problems with pregnancy or childbirth. Do not use rectal aspirin without medical advice if you are pregnant or plan to become pregnant.

It is not known whether rectal aspirin passes into breast milk or if it could harm an unborn baby. Do not use this medication without medical advice if you are breast-feeding a baby.

How should I use rectal aspirin?

Use this medication exactly as directed on the label, or as it has been prescribed by your doctor. Do not use the medication in larger or smaller amounts, or use it for longer than recommended.

This medication comes with patient instructions for using the rectal suppository. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

Do not take an aspirin rectal suppository by mouth. It is for use only in your rectum.

Remove the outer wrapper from the suppository before inserting it. Avoid handling the suppository too long or it will melt in your hands.

Try to empty your bowel and bladder just before using the rectal aspirin suppository.

Lie on your back with your knees up toward your chest. Gently insert the suppository into your rectum about 1 inch.

For best results, stay lying down after inserting the suppository and hold it in your rectum for a few minutes. The suppository will melt quickly once inserted and you should feel little or no discomfort while holding it in. Avoid using the bathroom for at least an hour after using the suppository.

Call your doctor if you still have a sore throat after 2 days of using rectal aspirin, if you still have a fever after 3 days, or if you still have pain after 10 days of treatment (5 days for a child). Tell your doctor at any time if you have new or worsening symptoms.

This medication can cause you to have unusual results with certain medical tests. Tell any doctor who treats you that you are using rectal aspirin.

If you need surgery, tell the surgeon ahead of time that you are using rectal aspirin. You may need to stop using the medicine for a short time.

Store the rectal suppositories at cool room temperature away from moisture and heat. Do not refrigerate or freeze them.

What happens if I miss a dose?

Since rectal aspirin is sometimes used as needed, you may not be on a dosing schedule. If you are using the medication regularly, use the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and wait until your next regularly scheduled dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include severe nausea, vomiting, or diarrhea, ringing in the ears, confusion, headache, increased thirst, severe drowsiness, uncontrolled muscle twitching, shortness of breath, bloody urine, hallucinations, or seizure (convulsions).

What should I avoid while using rectal aspirin?

Ask a doctor or pharmacist before using any other cold, allergy, pain, or sleep medication. Aspirin (sometimes abbreviated as ASA) is contained in many combination medicines. Taking certain products together can cause you to get too much aspirin which can lead to an overdose. Check the label to see if a medicine contains aspirin or ASA.

Rectal aspirin side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using this medicine and call your doctor at once if you have a serious side effect such as:

  • black, bloody, or tarry stools;

  • blood in your urine;

  • coughing up blood or vomit that looks like coffee grounds;

  • pale skin, easy bruising or bleeding;

  • wheezing, chest tightness, trouble breathing;

  • decreased hearing or ringing in the ears;

  • seizure (convulsions); or

  • dizziness, confusion, or hallucinations.

Less serious side effects may include:

  • nausea, vomiting, stomach pain; or

  • rectal irritation.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Side Effects (complete list)

Aspirin dosing information

Usual Adult Dose for Osteoarthritis:

Initial dose: 3 g orally per day in divided doses
Maintenance: Adjust dose as needed for anti-inflammatory efficacy

Comments:
-Dosing should be individualized.
-Target plasma salicylate levels of 150 to 300 mcg/mL are associated with anti-inflammatory response while plasma salicylate levels greater than 200 mcg/mL are associated with a higher incidence of toxicity.

Uses: For the relief of the signs and symptoms of rheumatoid arthritis, osteoarthritis, and arthritis and pleurisy associated with systemic lupus erythematous.

Usual Adult Dose for Rheumatoid Arthritis:

Initial dose: 3 g orally per day in divided doses
Maintenance: Adjust dose as needed for anti-inflammatory efficacy

Comments:
-Dosing should be individualized.
-Target plasma salicylate levels of 150 to 300 mcg/mL are associated with anti-inflammatory response while plasma salicylate levels greater than 200 mcg/mL are associated with a higher incidence of toxicity.

Uses: For the relief of the signs and symptoms of rheumatoid arthritis, osteoarthritis, and arthritis and pleurisy associated with systemic lupus erythematous.

Usual Adult Dose for Systemic Lupus Erythematosus:

Initial dose: 3 g orally per day in divided doses
Maintenance: Adjust dose as needed for anti-inflammatory efficacy

Comments:
-Dosing should be individualized.
-Target plasma salicylate levels of 150 to 300 mcg/mL are associated with anti-inflammatory response while plasma salicylate levels greater than 200 mcg/mL are associated with a higher incidence of toxicity.

Uses: For the relief of the signs and symptoms of rheumatoid arthritis, osteoarthritis, and arthritis and pleurisy associated with systemic lupus erythematous.

Usual Adult Dose for Fever:

Oral:
300 to 650 mg orally every 4 to 6 hours as needed
Maximum dose: 4 g in 24 hours

Rectal:
300 to 600 mg rectally every 4 hours

Uses: As a temporary fever reducer or for the temporary relief of minor pain due to headache, menstrual pain, arthritis, muscle pain, or toothache.

Usual Adult Dose for Pain:

Oral:
300 to 650 mg orally every 4 to 6 hours as needed
Maximum dose: 4 g in 24 hours

Rectal:
300 to 600 mg rectally every 4 hours

Uses: As a temporary fever reducer or for the temporary relief of minor pain due to headache, menstrual pain, arthritis, muscle pain, or toothache.

Usual Adult Dose for Myocardial Infarction:

Immediate-Release:
Initial dose: 160 to 162.5 mg orally once as soon as myocardial infarction is suspected
Maintenance dose: 160 to 162.5 mg orally once a day for 30 days post-infarction

Comments:
-Extended-release products should not be used when a rapid onset of action is desired such as suspected MI; non-enteric tablet may be chewed or crushed for immediate-action.
-This drug has been shown to reduce the risk of vascular mortality in patients with a suspected acute MI.
-After 30 days, secondary prophylaxis for prevention of recurrent MI should be considered.

Use: For treatment of a suspected myocardial infarction.

Usual Adult Dose for Ischemic Stroke:

Immediate-release: 50 to 325 mg orally once a day

Extended-release (ER): 162.5 mg orally once a day

Comments:
-Therapy should be continued indefinately.
-ER capsules are designed to slowly release drug from encapsulated microparticles thereby prolonging the absorption across the gastrointestinal tract; the pharmacodynamic effect of ER 162.5 mg is similar to that attained with IR aspirin 81 mg..

Uses: To reduce the risk of death and recurrent stroke in patients who have had ischemic stroke or transient ischemia attack.

Usual Adult Dose for Ischemic Stroke -- Prophylaxis:

Immediate-release: 50 to 325 mg orally once a day

Extended-release (ER): 162.5 mg orally once a day

Comments:
-Therapy should be continued indefinately.
-ER capsules are designed to slowly release drug from encapsulated microparticles thereby prolonging the absorption across the gastrointestinal tract; the pharmacodynamic effect of ER 162.5 mg is similar to that attained with IR aspirin 81 mg..

Uses: To reduce the risk of death and recurrent stroke in patients who have had ischemic stroke or transient ischemia attack.

Usual Adult Dose for Angina Pectoris Prophylaxis:

Immediate-release (IR): 75 mg to 325 mg orally once a day

Extended-release (ER): 162 mg orally once a day

Comments:
-Therapy should be continued indefinitely .
-The optimal dose to prevent cardiovascular events is unknown; however, higher doses are associated with increased risk of bleeding.
-Current evidence supports use of low-dose IR aspirin 75 to 100 mg daily.
-ER capsules are designed to slowly release drug from encapsulated microparticles thereby prolonging the absorption across the gastrointestinal tract; the pharmacodynamic effect of ER 162.5 mg is similar to that attained with IR aspirin 81 mg.

Uses: To reduce the combined risk of death and nonfatal myocardial infarction (MI) in patients with unstable angina pectoris and reduce the combined risk of MI and sudden death in patients with chronic stable angina pectoris.

Usual Adult Dose for Angina Pectoris:

Immediate-release (IR): 75 mg to 325 mg orally once a day

Extended-release (ER): 162 mg orally once a day

Comments:
-Therapy should be continued indefinitely .
-The optimal dose to prevent cardiovascular events is unknown; however, higher doses are associated with increased risk of bleeding.
-Current evidence supports use of low-dose IR aspirin 75 to 100 mg daily.
-ER capsules are designed to slowly release drug from encapsulated microparticles thereby prolonging the absorption across the gastrointestinal tract; the pharmacodynamic effect of ER 162.5 mg is similar to that attained with IR aspirin 81 mg.

Uses: To reduce the combined risk of death and nonfatal myocardial infarction (MI) in patients with unstable angina pectoris and reduce the combined risk of MI and sudden death in patients with chronic stable angina pectoris.

Usual Adult Dose for Revascularization Procedures -- Prophylaxis:

For coronary artery bypass graft (CABG):
325 mg orally once a day beginning 6 hours after the procedure and continuing for 1 year

For percutaneous transluminal coronary angiography (PTCA):
325 mg orally once 2 hours prior to procedure, then 160 to 325 mg orally once a day indefinitely

For carotid endarterectomy:
80 mg orally once a day up to 650 mg orally twice a day beginning prior to surgery and continuing indefinitely

Comments:
-Current guidelines should be consulted for use of dual antiplatelet therapy (low-dose aspirin plus ticagrelor, clopidogrel, or prasugrel)

Uses: For patients who have undergone revascularization procedures including CABG, PTCA, or carotid endarterectomy when there is a preexisting condition for which aspirin is already indicated.

Usual Adult Dose for Ankylosing Spondylitis:

Up to 4 g orally per day in divided doses
Maintenance dose: Adjust dose as needed for anti-inflammatory efficacy

Comments:
-Doses should be individualized.
-Target plasma salicylate levels of 150 to 300 mcg/mL are associated with anti-inflammatory response while plasma salicylate levels greater than 200 mcg/mL are associated with a higher incidence of toxicity.

Uses: For the relief of the signs and symptoms of spondyloarthropathies.

Usual Adult Dose for Myocardial Infarction -- Prophylaxis:

Primary Prophylaxis:
-50 years or older: 75 to 100 mg orally once a day
-Adults with type 1 or type 2 diabetes at increased CVD risk: 75 to 162 mg orally once a day

Comments:
-In adults 50 to 59 years who have a 10% or greater 10-year CVD risk, are not at increased risk of bleeding, and have a life expectancy of at least 10 years, the United States Preventative Services Task Force (USPSTF) recommends initiating low dose aspirin for the primary prevention of atherosclerotic cardiovascular disease (ASCVD) and colorectal cancer (CRC).
-The decision to initiate primary prophylaxis therapy in adults 60 to 69 years, should include the same parameters and additionally be individualized for risk; for adults 70 years or older, the current evidence is insufficient to assess the balance of benefits and harms.
-The American Diabetes Association Standards of Care recommends primary prophylaxis in adults with diabetes who are at increased risk of CVD; this includes most patients 50 years or older with at least 1 additional major risk factor; for patients less than 50 years, clinical judgement is required.

Secondary Prophylaxis:
Immediate-release (IR): 75 mg to 325 mg orally once a day
Extended-release (ER): 162.5 orally once a day

Comments:
-The optimal dose to prevent cardiovascular events is unknown; however, higher doses are associated with increased risk of bleeding.
-Current evidence supports use of low-dose IR aspirin 75 to 100 mg daily.
-ER capsules are designed to slowly release drug from encapsulated microparticles thereby prolonging the absorption across the gastrointestinal tract; the pharmacodynamic effect of ER 162.5 mg is similar to that attained with IR aspirin 81 mg.

Use: To reduce the combined risk of death and nonfatal myocardial infarction (MI) in patients with chronic coronary artery disease, such as patients with a previous MI.

Usual Adult Dose for Cardiovascular Risk Reduction:

Primary Prophylaxis:
-50 years or older: 75 to 100 mg orally once a day
-Adults with type 1 or type 2 diabetes at increased CVD risk: 75 to 162 mg orally once a day

Comments:
-In adults 50 to 59 years who have a 10% or greater 10-year CVD risk, are not at increased risk of bleeding, and have a life expectancy of at least 10 years, the United States Preventative Services Task Force (USPSTF) recommends initiating low dose aspirin for the primary prevention of atherosclerotic cardiovascular disease (ASCVD) and colorectal cancer (CRC).
-The decision to initiate primary prophylaxis therapy in adults 60 to 69 years, should include the same parameters and additionally be individualized for risk; for adults 70 years or older, the current evidence is insufficient to assess the balance of benefits and harms.
-The American Diabetes Association Standards of Care recommends primary prophylaxis in adults with diabetes who are at increased risk of CVD; this includes most patients 50 years or older with at least 1 additional major risk factor; for patients less than 50 years, clinical judgement is required.

Secondary Prophylaxis:
Immediate-release (IR): 75 mg to 325 mg orally once a day
Extended-release (ER): 162.5 orally once a day

Comments:
-The optimal dose to prevent cardiovascular events is unknown; however, higher doses are associated with increased risk of bleeding.
-Current evidence supports use of low-dose IR aspirin 75 to 100 mg daily.
-ER capsules are designed to slowly release drug from encapsulated microparticles thereby prolonging the absorption across the gastrointestinal tract; the pharmacodynamic effect of ER 162.5 mg is similar to that attained with IR aspirin 81 mg.

Use: To reduce the combined risk of death and nonfatal myocardial infarction (MI) in patients with chronic coronary artery disease, such as patients with a previous MI.

Usual Adult Dose for Colorectal Cancer:

50 years or older: 75 to 100 mg orally once a day

Comments:
-In adults 50 to 59 years who have a 10% or greater 10-year CVD risk, are not at increased risk of bleeding, and have a life expectancy of at least 10 years, the United States Preventative Services Task Force (USPSTF) recommends initiating low dose aspirin for the primary prevention of atherosclerotic cardiovascular disease (ASCVD) and colorectal cancer (CRC).
-The decision to initiate primary prophylaxis therapy in adults 60 to 69 years, should include the same parameters and additionally be individualized for risk; for adults 70 years or older, the current evidence is insufficient to assess the balance of benefits and harms.

Use: For the primary prevention of colorectal cancer.

Usual Pediatric Dose for Fever:

12 years or older: 300 to 650 mg orally every 4 to 6 hours as needed
Maximum dose: 4 g in 24 hours

Comments:
-This drug should be avoided in pediatric patients with viral illness due to risk of Reye's syndrome.

Uses: As a temporary fever reducer or for the temporary relief of minor pain due to headache, menstrual pain, arthritis, muscle pain, or toothache.

Usual Pediatric Dose for Pain:

12 years or older: 300 to 650 mg orally every 4 to 6 hours as needed
Maximum dose: 4 g in 24 hours

Comments:
-This drug should be avoided in pediatric patients with viral illness due to risk of Reye's syndrome.

Uses: As a temporary fever reducer or for the temporary relief of minor pain due to headache, menstrual pain, arthritis, muscle pain, or toothache.

Usual Pediatric Dose for Juvenile Rheumatoid Arthritis:

Initial dose: 90 to 130 mg/kg orally in divided doses
Maintenance dose: Increase as needed for anti-inflammatory efficacy.

Comments:
-Dosing should be individualized.
-Target plasma salicylate levels of 150 to 300 mcg/mL are associated with anti-inflammatory response while plasma salicylate levels greater than 200 mcg/mL are associated with a higher incidence of toxicity.

Uses: For the relief of the signs and symptoms of juvenile rheumatoid arthritis.

Usual Pediatric Dose for Kawasaki Disease:

Initial (acute phase): 80 to 100 mg/kg orally in divided doses for up to 14 days (as an anti-inflammatory agent)
Followed by: 1 to 5 mg/kg orally per day for 6 to 8 weeks (as an antiplatelet agent)

Comments:
-Intravenous Immune Globulin is recommended within 10 days of symptom onset.
-For children with moderate or giant coronary aneurysms following Kawasaki disease, warfarin may be needed in addition to low-dose aspirin; consult guidelines.
-For children who have giant aneurysms and acute coronary artery thrombosis, thrombolysis or acute surgical intervention is recommended.

Use: For the treatment of Kawasaki disease.

Usual Pediatric Dose for Thrombotic/Thromboembolic Disorder:

1 to 5 mg/kg orally per day

Comments:
- The American College of Chest Physicians provides guidance on use of aspirin as antithrombotic therapy in neonates and children; their evidence based guidelines should be consulted for further guidance.
-May be used in neonates with recurrent Arterial Ischemic Stroke (AIS).
-For children with acute AIS, with or without thrombophilia, aspirin may be considered as initial therapy until dissection and embolic causes have been excluded; once dissection and cardioembolic causes are excluded, daily aspirin prophylaxis should continue for a minimum of 2 years.
-May be used for thromboprophylaxis in neonates and children after Modified Blalock-Taussig Shunts (MBTS) surgery; may be used in children after Fontan surgery
-For children with Ventricular Assist Devices (VADs) antiplatelet therapy (either aspirin or aspirin and dipyridamole) should begin within 72 hours of VAD placement.
-For children with acute AIS secondary to non-Moyamoya vasculopathy, aspirin may be considered as one option for initial therapy (for 3 months); ongoing antithrombotic therapy should be guided by repeat cerebrovascular imaging.
-For children with acute AIS secondary to Moyamoya, aspirin therapy should be considered; children should be referred to an appropriate center for consideration of revascularization.

Use: For antithrombotic therapy and prevention of thrombosis in neonates and children.

What other drugs will affect rectal aspirin?

Ask your doctor before using an antidepressant such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, Symbyax), fluvoxamine (Luvox), paroxetine (Paxil), or sertraline (Zoloft). Taking any of these medicines while you are using aspirin may cause you to bruise or bleed easily.

Ask a doctor or pharmacist if it is safe for you to use rectal aspirin if you are also using any of the following drugs:

  • alprostadil (Caverject, Edex);

  • eptifibatide (Integrilin);

  • tirofiban (Aggrastat);

  • probenecid (Benemid);

  • divalproex (Depakote) or valproic acid (Depacon, Depakene);

  • an antacid or laxative;

  • a blood thinner such as heparin or warfarin (Coumadin, Jantoven);

  • cancer medicine such as abciximab (Reopro), methotrexate (Folex, Rheumatrex, Trexall);

  • insulin or oral diabetes medicine;

  • an antibiotic such as cefemandole (Maxipime), cefotetan (Cefotan), ciprofloxacin (Cipro), demeclocycline (Declomycin), doxycycline (Doryx, Periostat, Vibramycin), minocycline (Dynacin, Minocin), norfloxacin (Noroxin), ofloxacin (Floxin), piperacillin (Pipracil), tetracycline (Ala-Tet, Sumycin, Tetracap), ticarcillin (Ticar), vancomycin (Vancocin);

  • an antifungal such as itraconazole (Sporanox) or ketoconazole (Nizoral);

  • medication used to prevent blood clots, such as alteplase (Activase), clopidogrel (Plavix), dipyridamole (Persantine), ticlopidine (Ticlid), and urokinase (Abbokinase);

  • salicylates such as Disalcid, Doan's Pills, Dolobid, Salflex, Tricosal; or

  • NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn, Naprelan, Treximet), celecoxib (Celebrex), diclofenac (Arthrotec, Cambia, Cataflam, Voltaren, Flector Patch, Pennsaid, Solareze), indomethacin (Indocin), meloxicam (Mobic), and others.

This list is not complete and other drugs may interact with rectal aspirin. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Where can I get more information?

  • Your pharmacist can provide more information about rectal aspirin.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 1.11.

Last reviewed: June 12, 2012
Date modified: November 15, 2017

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