aspirin (Zorprin, Bayer Buffered Aspirin, Durlaza, Asatab, Adprin-B, Alka-Seltzer Extra Strength with Aspirin, Alka-Seltzer with Aspirin, Arthritis Pain Formula, Ascriptin, Ascriptin Maximum Strength, ASA, Bayer Children's Aspirin, Bayer Women's Low Dose, Bayer Low Adult Strength, Bayer Advanced Aspirin, Bayer Extra Strength, Bayer Extra Strength Plus, Bufferin, Bufferin Extra Strength, Ecotrin, Ecotrin Maximum Strength, Empirin, Extended Release Bayer 8-Hour Caplets, Extra Strength Bayer Plus Caplets, Genuine Bayer Aspirin, Halfprin, Maximum Bayer Aspirin, St. Joseph Adult Chewable Aspirin, St. Joseph Regular Strength, acetylsalicylic acid)

Dosing and uses of Zorprin, Bayer Buffered Aspirin (aspirin)

• Adult
• Pediatric

 

Adult dosage forms and strengths

tablet

• 81mg
• 325mg
• 500mg

tablet, delayed-release

• 162mg
• 325mg
• 500mg

tablet, chewable

• 75mg
• 81mg

tablet, enteric-coated

• 81mg
• 162mg
• 325mg
• 650mg

gum, chewing, oraL

• 227mg

extended-release capsule (Durlaza [Rx])

• 162.5 mg

 

Pain & Fever

325-650 mg PO/PR q4-6hr PRn

Controlled/extended/delayed-release products (enteric-coated): 650-1300 mg PO q8hr; not to exceed 3.9 g/day

 

Acute Coronary Syndrome

For use as adjunctive antithrombotic effects for ACS (ST-segment elevation myocardial infarction [STEMI], unstable angina [UA]/non-ST-segment elevation myocardial infarction [NSTEMI])

Acute symptoms

• 160-325 mg PO; chew nonenteric-coated tablet upon presentation (within minutes of symptoms)
• If unable to take PO, may give 300-600 mg suppository PR

Maintenance (secondary prevention)

• 75-81 mg PO qDay indefinitely (preferred dose); may give 81-325 mg/day
• Regimen may depend on coadministered drugs or comorbid conditions
• Coadministered with ticagrelor: 81 mg PO qDay

Percutaneous transluminal coronary angioplasty

• Adjunctive aspirin therapy to support reperfusion with primary PCI (with or without fibrinolytic therapy)
• Preoperative dose: 162-325 mg PO before procedure
• Maintenance: 81 mg PO qDay indefinitely (preferred dose) may give 81-325 mg/day
• Regimen may depend on coadministered drugs or comorbid conditions
• Coadministered with ticagrelor: 81 mg PO qDay

 

Primary & Secondary Prevention

Durlaza: Indicated to reduce the risk of death and MI in patients with chronic CAD (eg, history of MI, unstable angina, or chronic stable angina); also indicated to reduce the risk of death and recurrent stroke in patients who have had an ischemic stroke or TIA

Extended-release capsule (Durlaza [Rx]): 162.5 mg PO qDay

Use immediate-release aspirin, not extended release capsule in situations where a rapid onset of action of action is required (such as acute treatment of myocardial infarction or before percutaneous coronary intervention)

 

Ischemic Stroke & Transient Ischemic Attack

50-325 mg/day PO within 48 hours of stroke or TIA, then 75-100 mg/day PO

 

Osteoarthritis

Up to 3 g/day PO in divided doses

 

Rheumatoid Arthritis

3 g/day PO in divided doses; increased PRN for anti-inflammatory efficacy (target plasma salicylate, 150-300 mcg/mL) 

 

Spondyloarthropathy

3.6-5.4 g/day PO in divided doses; monitor serum concentrations

 

Colorectal Cancer (Off-label)

Prophylaxis

600 mg/day PO

Decreases risk of developing hereditary colorectal cancer (ie, Lynch syndrome) by 60% if taken daily for at least 2 years

 

Dosing Modifications

Renal impairment

• CrCl >10 mL/min: Dose adjustment not necessary
• CrCl <10 mL/min: Not recommended

Hepatic impairment

• Severe liver disease: Not recommended

 

Pediatric dosage forms and strengths

tablet

• 81mg
• 325mg
• 500mg

tablet, delayed release

• 162mg
• 325mg
• 500mg

tablet, chewable

• 75mg
• 81mg

tablet, enteric coated

• 81mg
• 162mg
• 325mg
• 650mg

gum, chewing, oraL

• 227mg

 

Pain & Fever

<12 years

• 10-15 mg/kg PO q4hr, up to 60-80 mg/kg/day

≥12 years

• 325-650 mg PO/PR q4-6hr PRN
• Controlled/extended/delayed-release products (enteric coated): 650-1300 mg PO q8hr; not to exceed 3.9 g/day

 

Juvenile Rheumatoid Arthritis

<25 kg: 60-100 mg/kg/day PO divided q6-8hr (maintain serum salicylate at 150-300 mcg/mL)

≥25 kg: 2.4-3.6 g/day

 

Kawasaki Disease

Febrile phase: 80-100 mg/kg/day PO divided q6hr for up to 14 days (48-72 hours after fever defervescence)

Maintenance: 3-6 mg/kg/day PO in single dose

 

Dosing Considerations

Toxic dose: 200 mg/kg

 

Zorprin, Bayer Buffered Aspirin (aspirin) adverse (side) effects

Frequency not defined

Angioedema

Bronchospasm

CNS alteration

Dermatologic problems

GI pain, ulceration, bleeding

Hepatotoxicity

Hearing loss

Nausea

Platelet aggregation inhibition

Premature hemolysis

Pulmonary edema (salicylate-induced, noncardiogenic)

Rash

Renal damage

Tinnitus

Urticaria

Vomiting

 

Warnings

Contraindications

Hypersensitivity to aspirin or NSAIDs; aspirin-associated hypersensitivity reactions include aspirin-induced urticaria (HLA-DRB1*1302-DQB1*0609 haplotype), aspirin-intolerant asthma (HLA-DPB1*0301)

Allergy to tartrazine dye

Absolute

• Bleeding GI ulcers, hemolytic anemia from pyruvate kinase (PK) and glucose-6-phosphate dehydrogenase (G6PD) deficiency, hemophilia, hemorrhagic diathesis, hemorrhoids, lactating mother, nasal polyps associated with asthma, sarcoidosis, thrombocytopenia, ulcerative colitis

Relative

• Appendicitis, asthma (bronchial), chronic diarrhea, bowel outlet obstruction (for enteric-coated formulations), dehydration, erosive gastritis, hypoparathyroidism

 

Cautions

Anemia, GI malabsorption, history of peptic ulcers, gout, hepatic disease, hypochlorhydria, hypoprothrombinemia, renal impairment, thyrotoxicosis, vitamin K deficiency, renal calculi, ethanol use (may increase bleeding)

Discontinue therapy if tinnitus develops

Should be taken with food or 8-12 oz of water to avoid GI effects

Not indicated for children with viral illness; use of salicylates in pediatric patients with varicella or influenzalike illness is associated with increased incidence of Reye syndrome

Heart Failure (HF) risk

• NSAIDS have the potential to trigger HF by prostaglandin inhibition that leads to sodium and water retention, increased systemic vascular resistance, and blunted response to diuretics
• High-dose aspirin (greater than 325mg) should be avoided or withdrawn whenever possible
• AHA/ACC Heart Failure Guidelines; Circulation. 2016; 134

 

Pregnancy and lactation

Pregnancy category: C; D in 3rd trimester (expert analysis); it is especially important that patient not use aspirin during last 3 months of pregnancy unless specifically directed to do so by doctor, because it may cause problems in unborn child or complications during delivery.

Lactation: Drug enters breast milk; decision should be made regarding whether to discontinue nursing or to discontinue drug, taking into account importance of drug to mother.

 

Pregnancy categories

A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA: Information not available.

 

Pharmacology of Zorprin, Bayer Buffered Aspirin (aspirin)

Mechanism of action

Inhibits synthesis of prostaglandin by cyclooxygenase; inhibits platelet aggregation; has antipyretic and analgesic activity 

 

Absorption

Bioavailability: 80-100%

Onset: PO, 5-30 min; PR, 1-2 hr

Duration: PO, 4-6 hr; PR, >7 hr

Peak plasma time: PO, 0.25-3 hr

Peak plasma concentration: Analgesia/antipyresis, 30-100 mcg/mL; anti-inflammatory, 150-300 mcg/mL

 

Distribution

Protein bound: ≤100 mcg/mL, 90-95%; 100-400 mcg/mL, 70-85%; higher concentrations, 25-60%

Vd: 170 mL/kg

 

Metabolism

Metabolized by liver via microsomal enzyme system

Metabolites: Salicylurate, salicyl phenolic glucuronide, salicyl acyl glucuronide, 2,5-dihydroxybenzoic acid (gentisic acid), 2,3-dihydroxybenzoic acid, 2,3,5-trihydroxybenzoic acid, gentisuric acid (active)

Enzymes inhibited: Cyclooxygenase (insignificant)

 

Elimination

Half-life: Low dose, 2-3 hr; higher dose, 15-30 hr

Renal clearance: 80-100% in 24-72 hr

Excretion: Urine (80-100%), sweat, saliva, feces

Dialyzable: Yes