Aspirin is used in the treatment of a number of conditions, including fever, pain,

rheumatic fever, and inflammatory diseases, such as rheumatoid arthritis,

pericarditis, and Kawasaki disease.[17] Lower doses of aspirin have also shown to
reduce the risk of death from a heart attack, or the risk of stroke in some
circumstances.[18][19][20] There is some evidence that aspirin is effective at
preventing colorectal cancer, though the mechanisms of this effect are unclear.[21]

Pain[edit]

Aspirin 325 mg for pain

Uncoated aspirin tablets, consisting of about 90% acetylsalicylic acid, along with a
minor amount of inert fillers and binders
Aspirin is an effective analgesic for acute pain, but is generally considered inferior
to ibuprofen for the alleviation of pain because aspirin is more likely to cause
gastrointestinal bleeding.[22] Aspirin is generally ineffective for those pains caused
by muscle cramps, bloating, gastric distension, or acute skin irritation.[23] As with
other NSAIDs, combinations of aspirin and caffeine provide slightly greater pain
relief than aspirin alone.[24] Effervescent formulations of aspirin, such as AlkaSeltzer or Blowfish,[25] relieve pain faster than aspirin in tablets,[26] which makes
them useful for the treatment of migraines.[27]

Topical aspirin may be effective for treating some types of neuropathic pain.[28]

Headache[edit]
Aspirin, either by itself or in a combined formulation, effectively treats some types
of headache, but its efficacy may be questionable for others. Secondary headaches,
meaning those caused by another disorder or trauma, should be promptly treated
by a medical provider.

Among primary headaches, the International Classification of Headache Disorders

distinguishes between tension headache (the most common), migraine, and cluster
headache. Aspirin or other over-the-counter analgesics are widely recognized as
effective for the treatment of tension headache.[29] Aspirin, especially as a

component of an acetaminophen/aspirin/caffeine formulation, e.g., Excedrin

Migraine, is considered a first-line therapy in the treatment of migraine, and
comparable to lower doses of sumatriptan. It is most effective at stopping migraines
when they are first beginning.[30]

Fever[edit]
Like its ability to control pain, aspirin's ability to control fever is due to its action on
the prostaglandin system through its irreversible inhibition of COX.[31] Although
aspirin's use as an antipyretic in adults is well-established, many medical societies
and regulatory agencies (including the American Academy of Family Physicians, the
American Academy of Pediatrics, and the U.S. Food and Drug Administration (FDA)
strongly advise against using aspirin for treatment of fever in children because of
the risk of Reye's syndrome, a rare but often fatal illness associated with the use of
aspirin or other salicylates in children during episodes of viral or bacterial infection.
[32][33][34] Because of the risk of Reye's syndrome in children, in 1986, the FDA
required labeling on all aspirin-containing medications advising against its use in
children and teenagers.[35]

Swelling and inflammation[edit]

Aspirin is used as an anti-inflammatory agent for both acute and long-term
inflammation,[36] as well as for treatment of inflammatory diseases, such as
rheumatoid arthritis.[17]

Heart attacks and strokes[edit]

The first studies of the effect of aspirin on cardiac function and stroke prevention
was carried out by Professor Peter Sleight,[37] Emeritus Professor of Cardiovascular
Medicine at Oxford University in the early 1970s.[38] Sleight and his research team
at Oxford led the way and formed the foundation for the research into the use of
aspirin in the prevention of other medical conditions.

For a subset of the population, aspirin may help prevent heart attacks and strokes.
In lower doses, aspirin has been known to prevent the progression of existing
cardiovascular disease, and reduce the frequency of these events for those with a
history of them.[39][40] (This is known as secondary prevention.)

Aspirin appears to offer little benefit to those at lower risk of heart attack or stroke
for instance, those without a history of these events or with pre-existing disease.
(This is called primary prevention.) Some studies recommend aspirin on a case-bycase basis,[41][42] while others have suggested the risks of other events, such as
gastrointestinal bleeding, were significant enough to outweigh any potential benefit,
and recommended against using aspirin for primary prevention entirely.[43]

Complicating the use of aspirin for prevention is the phenomenon of aspirin

resistance.[44][45] For patients who are resistant, aspirin's efficacy is reduced,
which can cause an increased risk of stroke.[46] Some authors have suggested
testing regimens to identify those patients who are resistant to aspirin or other
antithrombotic drugs (such as clopidogrel).[47]

Aspirin has also been suggested as a component of a polypill[48][49] for prevention

of cardiovascular disease.

After surgery[edit]
After percutaneous coronary interventions (PCIs), such as the placement of a
coronary artery stent, a U.S. Agency for Healthcare Research and Quality guideline
recommends that aspirin be taken indefinitely.[50] Frequently, aspirin is combined
with an ADP receptor inhibitor, such as clopidogrel, prasugrel, or ticagrelor to
prevent blood clots. This is called dual antiplatelet therapy (DAPT). United States
and European Union guidelines disagree somewhat about how long, and for what
indications this combined therapy should be continued after surgery. U.S. guidelines
recommend DAPT for at least 12 months, while EU guidelines recommend DAPT for
612 months after a drug-eluting stent placement.[51] However, they agree that
aspirin be continued indefinitely after DAPT is complete.

Cancer prevention[edit]
Aspirin reduces the overall risk of both getting cancer and dying from cancer.[52]
This effect is particularly beneficial for colorectal cancer (CRC).[21][53][54][55]

Some conclude the benefits are greater than the risks due to bleeding in those at
average risk.[52] Other are unclear if the benefits are greater than the risk.[56][57]
Given this uncertainty, the 2007 United States Preventive Services Task Force

guidelines on this topic recommended against the use of aspirin for prevention of
CRC in people with average risk.[58]

Other uses[edit]
Aspirin is a first-line treatment for the fever and joint-pain symptoms of acute
rheumatic fever. The therapy often lasts for one to two weeks, and is rarely
indicated for longer periods. After fever and pain have subsided, the aspirin is no
longer necessary, since it does not decrease the incidence of heart complications
and residual rheumatic heart disease.[59][60] Naproxen has been shown to be as
effective as aspirin and less toxic, but due to the limited clinical experience,
naproxen is recommended only as a second-line treatment.[59][61]

Along with rheumatic fever, Kawasaki disease remains one of the few indications for
aspirin use in children[62] in spite of a lack of high quality evidence for its
effectiveness.[63]

Low-dose aspirin supplementation has moderate benefits when used for prevention
of pre-eclampsia.[64][65]

Resistance[edit]
For some people, aspirin does not have as strong an effect on platelets as for
others, an effect known as aspirin resistance or insensitivity. One study has
suggested women are more likely to be resistant than men,[66] and a different,
aggregate study of 2,930 patients found 28% were resistant.[67] A study in 100
Italian patients, though, found, of the apparent 31% aspirin-resistant subjects, only
5% were truly resistant, and the others were noncompliant.[68] Another study of
400 healthy volunteers found no subjects who were truly resistant, but some had
"pseudoresistance, reflecting delayed and reduced drug absorption".[69]

Dosage[edit]

Coated 325-mg aspirin tablets

Adult aspirin tablets are produced in standardised sizes, which vary slightly from
country to country, for example 300 mg in Britain and 325 mg in the United States.

Smaller doses are based on these standards, e.g., 75-mg and 81-mg tablets. The
81-mg tablets are called "baby-strength", though they are not intended to be
administered to infants and children. No medical significance occurs due to the
slight difference in dosage between the 75-mg and the 81-mg tablets. Of historic
interest, in the United States, a 325-mg dose is equivalent to the historic 5-grain
aspirin tablet in use prior to the metric system.[citation needed]

In general, for adults, doses are taken four times a day for fever or arthritis,[70]
with doses near the maximal daily dose used historically for the treatment of
rheumatic fever.[71] For the prevention of myocardial infarction (MI) in someone
with documented or suspected coronary artery disease, much lower doses are taken
once daily.[70]

Recommendations from the USPSTF[72] on the use of aspirin for the primary
prevention of coronary heart disease encourage men aged 4579 and women aged
5579 to use aspirin when the potential benefit of a reduction in MI for men or
stroke for women outweighs the potential harm of an increase in gastrointestinal
hemorrhage.[73] The WHI study said regular low-dose (75- or 81-mg) aspirin female
users had a 25% lower risk of death from cardiovascular disease and a 14% lower
risk of death from any cause.[73] Low-dose aspirin use was also associated with a
trend toward lower risk of cardiovascular events, and lower aspirin doses (75 or 81
mg/day) may optimize efficacy and safety for patients requiring aspirin for longterm prevention.[73]

In children with Kawasaki disease, aspirin is taken at dosages based on body weight,
initially four times a day for up to two weeks and then at a lower dose once daily for
a further six to eight weeks.[74]

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

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 667668 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 832Use 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-STsegment-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 736822 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 1010or
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. 9991007
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.9961008

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).1003Aspirin
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 605626 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 810811 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 211 years of age: 1.5 g/m2 daily administered in 46 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

14.516 kg

160 mg

4<6 years

1620.5 kg

240 mg

6<9 years

20.530 kg

320 mg

9<11 years

3035 kg

320400 mg

11 years

3538 kg

320480 mg

For self-medication in children 12 years of age, 325650 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 211 years of age: 1.5 g/m2 daily administered in 46 divided doses (maximum 2.5
g/m2 daily).a
Children 12 years of age: 325650 mg every 4 hours as necessary (maximum 4 g daily). a

Fever
Oral
Children 211 years of age: 1.5 g/m2 daily administered in 46 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

14.516 kg

160 mg

4<6 years

1620.5 kg

240 mg

6<9 years

20.530 kg

320 mg

9<11 years

3035 kg

320400 mg

11 years

3538 kg

320480 mg

Children 12 years of age: 325650 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 211 years of age: 1.5 g/m2 daily administered in 46 divided doses (maximum 2.5
g/m2 daily).a
Children 12 years of age: 325650 mg every 4 hours as necessary (maximum 4 g daily). a

Inflammatory Diseases
Juvenile Rheumatoid Arthritis
Oral
Initially, 90130 mg/kg daily in divided doses.c m Increase dosage as necessary for anti-inflammatory
efficacy; target plasma salicylate concentration is 150300 mcg/mL. c m Plasma concentrations >200
mcg/mL associated with an increased incidence of toxicity.c m

Rheumatic Fever
Oral

Initially, 90130 mg/kg daily given in divided doses every 46 hours for up to 12 weeks for maximal
suppression of acute inflammation, followed by 6070 mg/kg daily in divided doses for 16
weeks.a Adjust dosage based on response, tolerance, and plasma salicylate
concentrations.aGradually withdraw over 12 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 15 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
15 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, 80100 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
15 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 68 weeks.638 950 1013

Adults
Pain
Oral
For self-medication, 325650 mg every 4 hours (maximum 4 g daily) or 0.51 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 [AlkaSeltzer Lemon-Lime or Original]) every 4 hours (maximum 2.6 g daily); alternatively, 1 g (AlkaSeltzer 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 [AlkaSeltzer Lemon-Lime or Original]) every 4 hours (maximum 1.3 g daily); alternatively, 1 g (AlkaSeltzer Extra Strength) every 6 hours (maximum 1.5 g daily).838 843 844

Rectal
325650 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
325650 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
325650 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 150300 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, 4.97.8 g daily in divided doses given for maximal suppression of acute inflammation. aAdjust
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
50325 mg daily;a m 646 990 some data suggest lower dosages (7581 mg daily) may have similar
benefits and possibly less bleeding risk.907
In patients with noncardioembolic ischemic stroke or TIA, 75100 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 160325 mg daily, initiated ideally within 48 hours of stroke onset; may decrease
dosage after 12 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
160325 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 75162 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 (75100 mg daily) in individuals 50 years
of age who do not have symptomatic cardiovascular disease. 1010

Established Coronary Artery Disease

Oral
75100 mg daily recommended by ACCP; continue indefinitely. 1010 Some data suggest lower dosages
(7581 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 162325 mg as soon as possible after diagnosis,
unless contraindicated or not tolerated.991 993 Continue with maintenance dosage of 75162 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: 81325 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 P2Y12receptor antagonist.994
Maintenance therapy following PCI and stent placement (drug-eluting or bare-metal): 75162 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 100325 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 75100 mg daily.1010

Embolism Associated with Atrial Fibrillation/Flutter

Oral
75325 mg daily for prevention of thromboembolism.1007

Mitral Valve Prolapse

Oral
75325 mg daily.996

Peripheral Arterial Disease

Oral
Primary prevention of cardiovascular events in patients with asymptomatic disease: 75100 mg
daily.1011
Secondary prevention of cardiovascular events in patients with symptomatic disease: 75100 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: 75100 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 belowthe-knee prosthetic graft bypass surgery.1011

Prosthetic Heart Valves

Mechanical Prosthetic Heart Valves
Oral
Aspirin 50100 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 75325 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: 50100 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: 50100 mg daily may be used for longterm antithrombotic therapy after initial 3-month treatment with warfarin. 1008

Combination aspirin (75100 mg daily) and warfarin therapy recommended by ACC/AHA for patients
with bioprosthetic heart valves and additional risk factors for thromboembolism.996
Aspirin 75325 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
162325 mg daily.635 821 Higher dosages (e.g., 650 mg every 46 hours) may be required.635 821

Complications of Pregnancy
Oral
Antiphospholipid syndrome and a history of multiple ( 3) pregnancy losses: Antepartum
prophylaxis with aspirin (75100 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 211 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 selfmedication for pain: 5 days.841 (See Advice to Patients.) Treatment duration for self-medicationof
sore throat pain using chewing gum: 2 days.837

Rectal

Children 211 years of age: Maximum 2.5 g/m2 daily.a

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

Fever
Oral
Children 211 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 selfmedication: <3 days.841 (See Advice to Patients.)

Rectal
Children 211 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 (AlkaSeltzerLemon-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 (AlkaSeltzerLemon-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 Reyes 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 890891 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.,
1215 g daily) of aspirin594 595 597 611 612 generally have not been observed in studies in which low doses
(60150 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 Reyes 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 638Generally 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 Reyes
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

Monitor BPc

inhibitorsc
Possible attenuation of
hemodynamic actions of ACE
inhibitors in patients with CHFh
Reduced hyponatremic effect of
ACE inhibitorsc m

Acidifying agents Drugs that decrease urine pH may

decrease salicylate excretionh

Alcohol

Increased risk of bleedingc m (see

Advice to Patients)

Alkalinizing

Drugs that increase urine pH may

Monitor plasma salicylate

agents

increase salicylate excretion

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 proteinbinding sites, leading to prolongation
of PT and bleeding timec m

Use with cautionh

Anticonvulsants

May displace phenytoin from binding Monitor patients receiving aspirin with
sites; possible decrease in total

valproic acidh

plasma phenytoin concentrations,

with increased free fractioncm
May displace valproic acid from
binding sites; possible increase in
free plasma valproic acid
concentrations;c hm possible
increased risk of bleedingh

Antidiabetic

Potential for increased hypoglycemic Monitor closelyh

drugs

effectc m

(sulfonylureas)

-adrenergic

Reduced BP response to -

blocking agents

adrenergic blocking agents c m

Monitor BPc

Potential for salt and fluid retentionm

Carbonic
anhydrase
inhibitors

Increased risk of salicylate toxicityh

Increased plasma acetazolamide

Avoid concomitant use in patients

receiving high-dose aspirinh

(acetazolamide)

concentrations; increased risk of

Corticosteroids

Decreased plasma salicylate

Monitor for adverse effects of either

concentrations

drugh

Diuretics

acetazolamide toxicitycm

Possible reduced natriuretic effectc

Methotrexate

Increased plasma methotrexate

Monitor for methotrexate toxicityh

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

NSAIAs

Increased risk of bleeding, GI

Concomitant use not

ulceration, decreased renal function,

recommendedc m p q r

or other complications861 m p q r
No consistent evidence that lowdose aspirin mitigates increased risk
of serious cardiovascular events

Pharmacokinetic interactions unlikely

to be clinically importanth
Immediate-release aspirin: Administer

associated with NSAIAs861 r

a single dose of ibuprofen 400 mg

Pharmacokinetic interactions with

30 minutes after administration of

many NSAIAsh

aspirin858 859

for self-medication8 hours before or

Antagonism (ibuprofen, naproxen) of Enteric-coated low-dose aspirin: No

the irreversible platelet-aggregation

recommendations regarding timing of

inhibitory effect of aspirin; may limit

administration with single dose of

the cardioprotective effects of

ibuprofen858 859

aspirin788 858859 860

Minimal risk of attenuating effects of

Consider use of alternative analgesics

that do not interfere with antiplatelet

low-dose aspirin with occasional use effect of low-dose aspirin (e.g.,

of ibuprofen858
Not known whether ketoprofen

acetaminophen, opiates) for patients at

high risk of cardiovascular events858 859

interferes with the antiplatelet effect

Concomitant use with prescription

of aspirin858 859

NSAIAs not recommended because of

potential for increased adverse

Decreased peak plasma

effects861

concentration and AUC of

diclofenac;p q limited data indicate
that diclofenac does not inhibit
antiplatelet effect of aspirin788

Pyrazinamide

Possible prevention or reduction of

hyperuricemia associated with
pyrazinamideh

Tetracycline

Decreased oral absorption of

Administer preparations containing

tetracyclines when administered with divalent or trivalent cations (Bufferin) 1

aspirin preparations containing

hr before or after tetracyclineh

divalent or trivalent cations

(Bufferin)h

Thrombolytic

Additive reduction in mortality

Used for therapeutic

agents

reported in patients with AMI

effect579 580 581 582 583 584 585 586 587 588589 590

receiving aspirin in low dosages and

thrombolytic agents (streptokinase,
alteplase)579 580 581 582 583584 585 586 587 588 589 590

Uricosuric

Reduced uricosuric effect of

agents

uricosuric agentsc m

(probenecid,
sulfinpyrazone)

Varicella virus

Theoretical possibility of Reyes

Manufacturer of varicella virus vaccine

vaccine live

syndrome

live recommends that individuals who

638

receive the vaccine avoid use of

salicylates for 6 weeks following

vaccination756
For children who are receiving longterm salicylate therapy, AAP suggests
weighing theoretical risks of
vaccination against known risks of
wild-type virus;638ACIP 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 12 hours after administration. m Peak plasma salicylic acid
concentrations attained within 12 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: 12 hours for antipyretic effects.h
Continuous oral therapy: 14 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 30100 mcg/mL produce analgesia and antipyresis; the
concentration required for anti-inflammatory effect is 150300 mcg/mL; toxicity noted at 300350
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: 9095% bound at plasma salicylate concentrations <100 mcg/mL; 7085% bound at
concentrations of 100400 mcg/mL; 2560% 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: 1520 minutes.a
Half-life of salicylate increases with increasing plasma salicylate concentrations. h m
Salicylate: 23 hours when aspirin administered in low doses (325 mg).h
Salicylate: 1530 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: 25C (may be exposed to 15
30C).738 Protect from excessive moisture.738

Gum
1525C; 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 (40C).840
1530C (Easprin).l
2025C (Anacin Extra Strength); protect from moisture.836
Protect from excessive heat (Alka-Seltzer products).838 843 844

Rectal
Suppositories
215C.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
drugs 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 841843 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 childs
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 breastfeed.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