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Aspirin acetylates the cyclooxygenase enzyme and thus inhibits it irreversibly. The analgesic activity of aspirin is mainly related to this mechanism of action and also has mild antipyretic activity. (1)

Mild to moderate pain Pyrexia (2)

Children below 16 years previous or active pepticulceration Haemophilia Aspirin and other NSAIDs are contraindicated in patients with a history of hypersensitivity to aspirin or any other NSAID—which includes those in whom attacks of asthma, angioedema, urticaria or rhinitishavebeen precipitated by aspirin or any other NSAID Severe hepatic and renal impairment Late pregnancy due to risk of closure of ductus arteriosus (2)

Generally mild and infrequent but high incidence of gastro-intestinal irritation with slightasymptomatic blood loss, increased bleeding time. Bronchospasm and skin reactions in hypersensitive patients. (2)

ACE inhibitors: Diminish the antihypertensive effect of ACE-inhibitors Diuretics: Reduce the natriuretic effect-of furosemide and thiazides in some patients Lithium: Elevation of plasma lithium levels and a reduction in renal lithium clearance Methotrexate: Enhanced toxicity of methotrexate Warfarin: Increased risk of gastrointestinal bleeding Other NSAIDs: Increased risk of GI bleeding (1)

Avoid in late pregnancy due to risk of closure of ductus arteriosus Caution in nursing mothers Contraindicated in children below 16 years and advanced renal and hepatic impairment (2)

Oral 300–900 mg every 4–6 hours when necessary; max. 4 g daily ; CHILDunder 16 years not recommended Rectal 50–900 mg every 4 hours (max. 3.6 daily); CHILDunder 16 years not recommended (2)

1.Grosser T, Smyth EM, Fitzgerald GA. Anti-inflammatory, Antipyretic, and Analgesic Agents; Pharmacotherapy of Gout. In: Brunton L, Chabner B, Knollmann B eds. Goodman & Gilman’s The Pharmacological basis of Therapeutics. 12th ed. China: McGraw Hill; 2011. P959-1005. 2. British National Formulary. 61st ed. BMA; 2011.