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)
Classes: Antiplatelet Agents, Cardiovascular; Antiplatelet Agents, Hematologic; NSAIDs; Salicylates
Dosing and uses of Zorprin, Bayer Buffered Aspirin (aspirin)
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