**BEERS Drug**


Trade Name(s)

  • Acuprin
  • Asaphen Canadian Tradename
  • Aspergum
  • Aspir-Low
  • Aspirtab
  • Bayer Aspirin
  • Bayer Timed-Release Arthritic Pain Formula
  • Easprin
  • Ecotrin
  • 8-Hour Bayer Timed-Release
  • Empirin
  • Entrophen Canadian Tradename
  • Halfprin
  • Healthprin
  • Lowprin Canadian Tradename
  • Norwich Aspirin
  • Novasen Canadian Tradename
  • Rivasa Canadian Tradename
  • Sloprin
  • St. Joseph Adult Chewable Aspirin
  • Therapy Bayer
  • Vazalore
  • ZORprin

Ther. Class.
antiplatelet agents
nonopioid analgesics

Pharm. Class.
nonsteroidal anti inflammatory drugs nsaids


  • Inflammatory disorders including:

    • Rheumatoid arthritis,
    • Osteoarthritis.
  • Mild to moderate pain.
  • Fever.
  • Prophylaxis of transient ischemic attacks and MI.

Unlabeled Use(s):

Adjunctive treatment of Kawasaki disease.


  • Produce analgesia and reduce inflammation and fever by inhibiting the production of prostaglandins.
  • Decreases platelet aggregation.

Therapeutic Effect(s):

  • Analgesia.
  • Reduction of inflammation.
  • Reduction of fever.
  • Decreased incidence of transient ischemic attacks and MI.


Absorption: Well absorbed from the upper small intestine; absorption from enteric-coated preparations may be unreliable; rectal absorption is slow and variable.

Distribution: Rapidly and widely distributed; crosses the placenta and enters breast milk.

Metabolism and Excretion: Extensively metabolized by the liver; inactive metabolites excreted by the kidneys. Amount excreted unchanged by the kidneys depends on urine pH; as pH increases, amount excreted unchanged increases from 2–3% up to 80%.

Half-life: 2–3 hr for low doses; up to 15–30 hr with larger doses because of saturation of liver metabolism.

TIME/ACTION PROFILE (analgesia/fever reduction)

PO5–30 min1–3 hr3–6 hr


Contraindicated in:

  • Hypersensitivity to aspirin or other salicylates;
  • Cross-sensitivity with other NSAIDs may exist (less with nonaspirin salicylates);
  • Bleeding disorders or thrombocytopenia;
  • OB:  Avoid use after 30 wk gestation;
  • Pedi:  May ↑ risk of Reye's syndrome in children or adolescents with viral infections.

Use Cautiously in:

  • History of GI bleeding or ulcer disease;
  • Chronic alcohol use/abuse;
  • Severe hepatic or renal disease;
  • OB:  Use at or after 20 wk gestation may cause fetal or neonatal renal impairment; if NSAID treatment is necessary between 20 wk and 30 wk gestation, limit use to the lowest effective dose and shortest duration possible
  • Lactation: Safety not established in breastfeeding;
  • Geri:  ↑ risk of adverse reactions in older adults, especially GI bleeding.

Adverse Reactions/Side Effects


EENT: tinnitus

GI: GI BLEEDING, dyspepsia, epigastric distress, nausea, abdominal pain, anorexia, hepatotoxicity, vomiting

Hemat: anemia, hemolysis


* CAPITALS indicate life-threatening.
Underline indicate most frequent.



  • May ↑ the risk of bleeding with  warfarin,  heparin,  heparin-like agents,  thrombolytic agents,  dipyridamole,  clopidogrel,  tirofiban, or  eptifibatide , although these agents are frequently used safely in combination and in sequence.
  •  Ibuprofen: may negate the cardioprotective antiplatelet effects of low-dose aspirin.
  • May ↑ risk of bleeding with  cefotetan  and  valproic acid.
  • May ↑ activity of  penicillins,  phenytoin,  methotrexate,  valproic acid,  oral hypoglycemic agents, and  sulfonamides.
  •  Urinary acidification  ↑ reabsorption and may ↑ serum salicylate levels.
  •  Alkalinization of the urine  or the ingestion of large amounts of  antacids  ↑ excretion and ↓ serum salicylate levels.
  • May blunt the therapeutic response to  diuretics  and  ACE inhibitors.
  • ↑ risk of GI irritation with  NSAIDs.

Drug-Natural Products:

↑ anticoagulant effect and bleeding risk with  arnica,  chamomile,  clove,  feverfew,  garlic,  ginger,  ginkgo,  Panax ginseng , and others.


Foods capable of acidifying the urine (see food sources for specific nutrients) may ↑ serum salicylate levels.



PO Rect:  (Adults): 325–1000 mg every 4–6 hr (not to exceed 4 g/day).  Extended-release tablets– 650 mg every 8 hr or 800 mg every 12 hr.

PO Rect:  (Children  2–11 yr): 10–15 mg/kg/dose every 4–6 hr; maximum dose: 4 g/day.


PO (Adults): 2.4 g/day initially; ↑ to maintenance dose of 3.6–5.4 g/day in divided doses (up to 7.8 g/day for acute rheumatic fever).

PO Children: 60–100 mg/kg/day in divided doses (up to 130 mg/kg/day for acute rheumatic fever).

Prevention of Transient Ischemic Attacks

PO (Adults): 50–325 mg once daily.

Prevention of Myocardial Infarction/Antiplatelet Effects

PO (Adults): 80–325 mg once daily.  Suspected acute MI– 160 mg as soon as MI is suspected.

PO Children: 3–10 mg/kg/day given once daily (round dose to a convenient amount).

Kawasaki Disease

PO Children: 80–100 mg/kg/day in 4 divided doses until fever resolves; may be followed by maintenance dose of 3–5 mg/kg/day as a single dose for up to 8 wk.

Availability (generic available)

Immediate-release tablets: 81 mgOTC, 162.5 mgOTC, 325 mgOTC, 500 mgOTC, 650 mgOTC, 975 mgOTC Canadian Tradename

Immediate-release capsules: 325 mgOTC

Extended-release tablets: 325 mgOTC Canadian Tradename, 650 mgOTC, 800 mg

Enteric-coated (delayed-release) tablets: 80 mgOTC, 165 mgOTC, 300 mgOTC Canadian Tradename, 325 mgOTC, 500 mgOTC, 600 mgOTC Canadian Tradename, 650 mgOTC, 975 mgOTC

Delayed-release capsules: 325 mgOTC Canadian Tradename, 500 mgOTC Canadian Tradename

Chewable tablets: 80 mgOTC Canadian Tradename, 81 mgOTC

Dispersible tablets: 325 mgOTC, 500 mgOTC

Suppositories: 60 mgOTC, 120 mgOTC, 125 mgOTC, 130 mgOTC, 150 mgOTC Canadian Tradename, 160 mgOTC Canadian Tradename, 195 mgOTC, 200 mgOTC, 300 mgOTC, 320 mgOTC Canadian Tradename, 325 mgOTC, 600 mgOTC, 640 mgOTC Canadian Tradename, 650 mgOTC, 1.2 gOTC

In Combination with: antihistamines, decongestants, cough suppressantsOTC , and opioids. See combination drugs.


  • Patients who have asthma, allergies, and nasal polyps or who are allergic to tartrazine are at an increased risk for developing hypersensitivity reactions.
  • Monitor for signs and symptoms of DRESS (fever, rash, lymphadenopathy, facial swelling) periodically during therapy. Discontinue therapy if symptoms occur.
  • Pain: Assess pain and limitation of movement; note type, location, and intensity before and 60 min after administration.
  • Fever: Assess fever and note associated signs (diaphoresis, tachycardia, malaise, chills).

Lab Test Considerations:

Monitor hepatic function before antirheumatic therapy and if symptoms of hepatotoxicity occur; more likely in patients, especially children, with rheumatic fever, systemic lupus erythematosus, juvenile arthritis, or pre-existing hepatic disease. May cause ↑ serum AST, ALT, and alkaline phosphatase, especially when plasma concentrations exceed 25 mg/100 mL. May return to normal despite continued use or dose reduction. If severe abnormalities or active liver disease occurs, discontinue and use with caution in future.

  • Monitor serum salicylate levels periodically with prolonged high-dose therapy to determine dose, safety, and efficacy, especially in children with Kawasaki disease.
  • May alter results of serum uric acid, urine vanillylmandelic acid (VMA), protirelin-induced thyroid-stimulating hormone (TSH), urine hydroxyindoleacetic acid (5-HIAA) determinations, and radionuclide thyroid imaging.
  • Prolongs bleeding time for 4–7 days and, in large doses, may cause prolonged prothrombin time. Monitor hematocrit periodically in prolonged high-dose therapy to assess for GI blood loss.

Toxicity Overdose:

Monitor for the onset of tinnitus, headache, hyperventilation, agitation, mental confusion, lethargy, diarrhea, and sweating. If these symptoms appear, withhold medication and notify health care professional immediately.


  • Use lowest effective dose for shortest period of time.
  • PO 

    Administer after meals or with food or an antacid to minimize gastric irritation. Food slows but does not alter the total amount absorbed.

    •  DNC: Do not crush or chew enteric-coated tablets. Do not take antacids within 1–2 hr of enteric-coated tablets. Chewable tablets may be chewed, dissolved in liquid, or swallowed whole. Some extended-release tablets may be broken or crumbled but must not be ground up before swallowing. See manufacturer's prescribing information for individual products.

Patient/Family Teaching

  • Instruct patient to take salicylates with a full glass of water and to remain in an upright position for 15–30 min after administration.

    • Advise patient to report tinnitus; unusual bleeding of gums; bruising; black, tarry stools; or fever lasting longer than 3 days.
    • Caution patient to avoid concurrent use of alcohol with this medication to minimize possible gastric irritation; 3 or more glasses of alcohol per day may increase risk of GI bleeding. Caution patient to avoid taking concurrently with acetaminophen or NSAIDs for more than a few days, unless directed by health care professional to prevent analgesic nephropathy.
    • Instruct patients on a sodium-restricted diet to avoid effervescent tablets or buffered-aspirin preparations.
    • Tablets with an acetic (vinegar-like) odor should be discarded.
    • Advise patients on long-term therapy to inform health care professional of medication regimen before surgery. Aspirin may need to be withheld for 1 wk before surgery.
    • Rep:  May cause fetal harm. Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding. Advise women to avoid aspirin in the 3rd trimester of pregnancy (after 29 wk), may cause premature closure of the fetal ductus arteriosus. Use of aspirin after 20 wk may cause fetal renal dysfunction leading to oligohydramnios. May cause reversible infertility in women attempting to conceive; may consider discontinuing aspirin.
    • Pedi:  Centers for Disease Control and Prevention warns against giving aspirin to children or adolescents with varicella (chickenpox) or influenza-like or viral illnesses because of a possible association with Reye's syndrome.
  • Transient Ischemic Attacks or MI: Advise patients receiving aspirin prophylactically to take only prescribed dose. Increasing dose has not been found to provide additional benefits.

Evaluation/Desired Outcomes

  • Relief of mild to moderate discomfort.
  • Increased ease of joint movement. May take 2–3 wk for maximum effectiveness.
  • Reduction of fever.
  • Prevention of transient ischemic attacks.
  • Prevention of MI.
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