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Aspirin

CARDIOVASCULAR SYSTEM

ANTIPLATELETS - [ CARDIOVASCULAR SYSTEM ]

Aspirin is a platelet inhibitor which acts by inhibition of the COX-1 enzyme. This results in decreased levels of thromboxane A2 resulting in decreased aggregation of platelets. However this antiplatelet action is specific at lower doses of aspirin.(1)

Ischemic stroke, transient ischemia attack, acute myocardial infarction (MI), prevention of recurrent MI, unstable angina pectoris, chronic stable angina pectoris. Revascularization procedures Rheumatologic diseases (2)

Hypersensitivity to aspirin or any other component of the formulation. Children or teenagers suffering from Reye’s syndrome. (2)

Fever, hypothermia, thirst Dysrhythmias, hypotension, tachycardia Agitation, cerebral edema, coma, confusion, dizziness, headache, cerebral hemorrhage, seizures Dehydration, hyperkalemia, acidosis Dyspepsia, GI bleeding, GI ulceration and perforation Prolongation of prothrombin time, DIC, thrombocytopenia Anaphylaxis, angioedema, asthma, urticaria Rhabdomyolysis, hypoglycemia and hyperglycemia Prolonged labour, stillbirths, low birth weight infants, antepartum and postpartum bleeding. Hyperpnea, pulmonary edema, tachypnea Hearing loss, interstitial nephritis, renal failure (2)

ACE inhibitors, beta blockers, diuretics: decreased effects of these drugs Acetazolamide, methotrexate: Increased levels of these drugs Phenytoin, warfarin, : Decreased levels of these drugs Heparin, warfarin, NSAIDs: increased risk of bleeding Oral hypoglycemics: might lead to hypoglycemia Probenecid and sulfinpyrazone: antagonism of uricosuric action of these durgs (2)

Should be avoided 1 week prior to labor and delivery since there can be excessive blood loss. Aspirin is excreted in human milk and can result in adverse effects in the nursing child (2)

Ischemic stroke and TIA: 50 to 325 mg orally once a day. Therapy should be continued indefinitely. Suspected acute MI: The initial dose of 160-162.5 mg is administered as soon as an MI is suspected. The maintenance dose of 160-162.5 mg/day is continued for 30 days post-infarction. After 30 days, consider further therapy based on dosage for prevention of recurrent MI. Prevention of recurrent MI, unstable angina pectoris, chronic stable angina pectoris: 75 to 325 mg orally once a day. Therapy should be continued indefinitely. CABG: 325 mg daily starting 6 hours post procedure. PTCA: 325 mg orally once 2 hours prior to procedure, then 160 to 325 mg orally once a day indefinitely. Carotid endarterectomy: 80 mg orally once a day up to 650 mg orally twice a day beginning prior to surgery and continuing indefinitely. Rheumatoid arthritis, Arthritis and pleurisy of SLE: The initial dose is 3 g a day in divided doses. Increased as necessary to reach a target blood level of 150-300 mcg/ml. Juvenile rheumatoid arthritis: Initial dose is 90-130 mg/kg/d in divided doses. Increased as necessary to reach a target blood level of 150-300 mcg/ml. Spondyloarthropathies: upto 4 g/day in divided doses. Osteoarthritis: upto 3 g/day in divided doses. (2)

1. Michel T, Hoffman BB. Treatment of myocardial ischemia and hypertension. In: Brunton L, Chabner B, Knollmann B eds. Goodman & Gilman’s The Pharmacological basis of Therapeutics. 12th ed. USA: McGraw Hill; 2011:746-88. 2. Aspirin comprehensive prescribing information [cited 2013 sept 12]. Available from: http://www.fda.gov/ohrms/dockets/ac/03/briefing/4012B1_03_Appd%201-Professional%20Labeling.pdf