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Aspirin (Systemic)

Introductory Information

NSAIA; salicylate ester of acetic acid.a

Class: 28:08.04.24 Salicylates; cn103 (VA primary); bl115 (VA primary); bl117 (VA primary)

Brands*: Aggrenox® (combination), Alka-Seltzer® (combination), Anacin® (combination), Ascriptin®,

Ascomp® (combination), Aspergum®, Bayer®, BC Powder® (combination), Bufferin®, Cope®
(combination), Damason-P® (combination), Darvon® (combination), Easprin®, Ecotrin®, Endodan®
(combination), Equagesic® (combination), Fiorinal® (combination), Fortabs® (combination),
Gelpirin® (combination), Genacote®, Goody's® (combination), Halfprin®, Lanorinal® (combination),
Micrainin® (combination), Norgesic® (combination), Percodan® (combination), Soma® Compound
(combination), St. Joseph®, Stanbeck Powder® (combination), Synalgos®-DC (combination),
Vanquish® (combination), ZORprin®

*also available generically

Generic Name: Aspirin

CAS Number: 50-78-2
Synonym: Acetylsalicylic Acid
Generic Name Abbreviation: ASA

Generic Name: Acetaminophen and Aspirin

Synonym: Aspirin and Acetaminophen

Generic Name: Acetaminophen, Aspirin, and Caffeine

Synonym: Aspirin, Acetaminophen, and Caffeine

Generic Name: Aspirin and Codeine Phosphate

Synonym: Co-codaprin, Codeine Phosphate and Aspirin

Generic Name: Oxycodone and Aspirin

Synonym: Aspirin and Oxycodone

Generic Name: Pentazocine Hydrochloride and Aspirin

Synonym: Aspirin and Pentazocine Hydrochloride

Generic Name: Propoxyphene Hydrochloride, Aspirin, and Caffeine

Synonym: Aspirin, Propoxyphene Hydrochloride, and Caffeine

Uses

Pain

Symptomatic relief of mild to moderate pain.a

Self-medication in children for the temporary relief of minor aches and pains and headache.841

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Self-medication in adolescents and adults for the temporary relief of minor aches and pains associated
with headache, common cold, toothache, muscular aches, backache, arthritis, menstrual cramps,836 and
sore throat.837, 840

Self-medication in fixed combination with acetaminophen and caffeine for the temporary relief of mild to
moderate pain associated with migraine headache;701, 702, 703 also can be used for the treatment of severe
migraine headache if previous attacks have responded to similar non-opiate analgesics or NSAIAs.701,
702, 703, 778

Fever

Self-medication for reduction of fever associated with colds, sore throats, and teething.837, 841 (See
Contraindications and see Pediatric Use under Cautions.)

Inflammatory Diseases

Symptomatic treatment of rheumatoid arthritis, juvenile rheumatoid arthritis, osteoarthritis,

spondyloarthropathies, and systemic lupus erythematosus (SLE).a, c, l, m

Rheumatic Fever

Symptomatic treatment of rheumatic fever .a A drug of choice in patients with mild carditis (without
cardiomegaly or CHF, with or without polyarthritis) or with polyarthritis only.h

TIAs and Acute Ischemic Stroke

Reduction of the risk of recurrent TIAs and stroke or death in patients who have had single or multiple
TIAs or ischemic stroke (secondary prevention).c, 646, 682, 691, 737, 818, 842, 881, m

Prevention of TIAs and stroke in patients undergoing carotid endarterectomy.646, 690, 769, 828, m In
patients with asymptomatic or recurrent carotid stenosis who are not candidates for surgery, lifelong
prophylaxis with aspirin is recommended by American College of Chest Physicians (ACCP).828

Aspirin, dipyridamole and aspirin, or clopidogrel all considered acceptable options by ACCP, AHA and
other clinicians for initial therapy in adults;818, 881 in children, aspirin recommended following
discontinuance of anticoagulation (e.g., unfractionated or LMW heparin, warfarin).825

Also used in fixed combination with extended-release dipyridamole to reduce the risk of recurrent stroke,
death from all vascular causes, or nonfatal MI in patients who have had TIAs or completed ischemic
stroke caused by thrombosis.691, 716, 738, 739, 743, 881, 883

Aspirin and dipyridamole combination or clopidogrel monotherapy may be preferable to aspirin

monotherapy for secondary prevention based on somewhat greater absolute risk reduction for stroke;
weigh benefit against additional costs of therapy.818

Acute treatment of ischemic stroke when thrombolytic therapy is contraindicated or not indicated.691,
699, 700, 716, 818, 862 May be safely used with low-dose sub-Q heparin to prevent DVT in such

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patients.818

Secondary Prevention of CAD and MI

Recommended by ACCP for reduction of the risk of vascular events in all patients with CAD regardless
of the presence or absence of clinical manifestations.820, 823, 828, 867

Reduction of the risk of vascular mortality in patients with suspected acute ST-segment elevation MI
(AMI).c, 579, 635, 636, 646, 669, 742, 765, 819, 820, 821, m

Reduction of the risk of stroke and recurrent infarction in patients surviving an MI (secondary
prevention).c, 579, 635, 646, 669, 742, 765, 820, 821, 842, m

Recommended by ACCP for use as monotherapy in low- to moderate-risk post-MI patients in most
health-care settings.820

Recommended by American Diabetes Association (ADA) for the prevention of cardiovascular events in
diabetic patients who have evidence of large-vessel disease (e.g., history of MI, CABG, stroke or TIA,
peripheral vascular disease, claudication, angina). 830, 901

Recommended by ACCP for use in combination with short-term oral anticoagulation (e.g., warfarin
therapy) in high-risk, post-MI patients (e.g., anterior MI or acute MI with severe left ventricular
dysfunction, congestive heart failure, previous emboli, or echocardiographic evidence of mural
thrombosis).820

Recommend by ACC and AHA for short-term use in combination withwarfarin in patients with left
ventricular thrombus and for long-term use in patients without an increased risk for bleeding.821

Recommended by ACC and AHA for use in combination with long-term warfarin therapy in patients
without coronary stents in whom other indications for anticoagulation exist (e.g., atrial
fibrillation,cerebral emboli, extensive wall-motion abnormality).821

Recommended by ACCP for use in combination with long-term oral anticoagulation (e.g., warfarin
therapy) in post-MI patients where meticulous INR monitoring is standard and routinely accessible.820

Has been used in combination with clopidogrel and other standard therapy (e.g., thrombolytic agents,
heparin) during acute MI to reduce mortality, recurrent MI, recurrent ischemia, or stroke.852, 853, 854, 855,
856, 862

Primary Prevention of CAD and MI

May reduce the risk of a first MI in certain patient populations (primary prevention).573, 574, 575, 576,
658, 659, 660, 661, 666, 667, 668, 669, 670, 671, 783, 785, 786, 820, 848, 851 Balance of risks and benefits is most

favorable in patients at moderate to high risk of CHD783, 820 (based on age and 10-year risk of cardiac
event >10%).668, 669, 820, 832 Use of aspirin in such patients is suggested over either warfarin or no
antithrombotic therapy.820

Recommended by ADA for primary prevention in patients with type 1 or type 2 diabetes mellitus who are

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at high risk for cardiovascular events (i.e., familial history of CHD, smoking, hypertension, obesity,
albuminuria, elevated blood cholesterol or triglyceride concentrations) and in whom aspirin is not
contraindicated.760, 830, 901

Benefit appears to be minimal or lacking in women at low risk for CHD, except possibly those ≥65 years
of age; further study needed.846, 847, 848, 849, 850, 851

Not currently recommended for primary prevention in the general population without known risk
factors.646, 658, 661, 662, 669, 674, 675, 676, 783, 784, 847

Unstable Angina or Non-ST-Segment Elevation MI

Reduction of the risk of death and/or nonfatal MI in patients with unstable angina or non-ST-segment
elevation (NSTE) acute coronary syndromes (ACSs).c, 581, 613, 614, 615, 616, 617, 618, 619, 620, 621, 669, 682,
684, 728, 736, 740, 765, 775, 820, m ACCP recommends use with low molecular weight heparins over

unfractionated heparin for the acute treatment of patients with NSTE ACSs.820

In patients with unstable angina or NSTE ACS who are not at high risk for bleeding, ACC and AHA
recommend adding clopidogrel to aspirin and heparin therapy for reduction of cardiovascular and
cerebrovascular events.765, 768, 771, 820, 823, 824, 833, 865, 866, 867, 868, 905

In patients with unstable angina and moderate to high-risk features, use in combination with other
antiplatelet therapies (e.g., tirofiban, eptifibatide) and heparin recommended by ACC, AHA, and
ACCP.820, 833

Chronic Stable Angina

Reduction of the risk of MI and/or sudden death in patients with chronic stable angina.c, 646, 669, 680, 728,
736, 820, 822, m

May administer with clopidogrel in selected high-risk patients with chronic stable angina.820

Percutaneous Coronary Intervention and Revascularization Procedures

Reduction of cardiovascular risks (e.g., early ischemic complications, graft closure) in patients
undergoing percutaneous coronary intervention (PCI) including coronary angioplastyc, 646, 686, 824, 865,
866 or stent implantation, 686, 824, 865, 866, 886, 887, 888, 889, m or CABG.c, 646, 683, 685, 781, 782, 823, m

Pretreatment with aspirin prior to PCI recommended by ACC and AHA.865, 867 Adjunctive therapy with
a loading dose of a thienopyridine derivative is preferred by ACCP over systemic anticoagulant therapy
prior to the procedure.771, 824, 865

For patients unable to tolerate aspirin, ACC and AHA suggest pretreatment with clopidogrel,865, 866
while ACCP suggests pretreatment with clopidogrel or ticlopidine prior to planned PCI.771, 824

Continue low-dose aspirin therapy indefinitely as secondary prevention against cardiovascular events
following PCI.824, 865, 867, 880 No evidence that such long-term therapy affects the rate of restenosis.686,

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771, 824

Recommended by ACC and AHA in combination with clopidogrel as short-term prophylaxis (≥1 month),
preferably long-term prophylaxis (≤1 year) after PCI in patients with bare-metal stents who are not at
high risk for bleeding.821, 865, 867

Prolonged prophylaxis (≤12 months) in combination with a thienopyridine derivative strongly

recommended after PCI in patients with drug-eluting stents (DES) who are not at high risk of
bleeding.886, 887, 888, 890, 891, 892, 894, 902 (See Thrombosis Associated with Drug-eluting Stents under
Cautions.)

Use in combination with clopidogrel suggested by ACC and AHA in patients undergoing brachytherapy
for restenosis following PCI and stent implantation .865

Recommended by ACCP for use in all patients undergoing saphenous vein or internal mammary artery
bypass grafting (regardless of effect on graft patency) based on indication in all patients with CAD.823
ACC and AHA recommend use after saphenous vein CABG to reduce risk of graft closure.867, 885

May be used in combination with oral anticoagulants in patients with saphenous vein bypass grafts who
have underlying conditions necessitating use of oral anticoagulants (e.g., prosthetic heart valves).768, 823

Embolism Associated with Atrial Fibrillation/Flutter

An alternative or adjunct to oral anticoagulation for reduction of the incidence of thromboembolic

episodes in selected patients with chronic atrial fibrillation or atrial flutter .744, 747, 749, 773, 774, 776,
826, 880

Use of either aspirin or warfarin is suggested by ACC, AHA, and other clinicians in patients with
nonvalvular atrial fibrillation with intermediate risk of stroke.826, k, n, o

Recommended for use in patients with atrial fibrillation at low risk for stroke or who are poor candidates
for oral anticoagulation.744, 747, 748, 749, 767, 773, 774, 776, 826, 880, 881, k, n, o

Recommended for use in patients with "lone" atrial fibrillation (e.g., those younger than 75 years of age
without prior stroke or TIA) over warfarin because relatively low risk of stroke in these patients does not
warrant risks of oral anticoagulation.

Embolism Associated with Valvular Heart Disease

Used as an alternative or adjunct to oral anticoagulation for reduction of the incidence of thromboembolic
episodes in selected patients with valvular heart disease .746, 764, 827, 881

Recommend by ACCP for use in patients with mitral valve prolapse and unexplained symptomatic
TIAs.827

Used as an adjunct to warfarin in patients with mitral valve disease associated with rheumatic fever and
recurrent embolism despite warfarin therapy.827, 881

Thrombosis in Other Arteries and Arteriovenous Communications

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Reduction of the risk of stroke and MI in patients undergoing peripheral percutaneous transluminal
angioplasty (PTA) with or without stenting.690, 828

Reduction of the risk of long-term cardiovascular morbidity and mortality in patients with chronic limb
ischemia (e.g., intermittent claudication) resulting from arteriosclerosis.690, 769, 828 Use of aspirin is
suggested by ACCP over clopidogrel in these patients because of cost considerations.828

Prolonging the patency of vascular grafts following peripheral bypass surgery (e.g., prosthetic
infrainguinal femoropopliteal).690, 769, 828 Prophylaxis used in selected patients undergoing other bypass
procedures and vascular reconstructions; consult specialized references for additional information.690,
769, 828

Has been used following initial heparin therapy to reduce the risk of thrombotic occlusion in children
with Blalock-Taussig shunts .662, 718, 825

Prosthetic Heart Valves

Has been used in conjunction with warfarin to reduce the risk of systemic thromboembolism and death in
patients with mechanical prosthetic heart valves .692, 693, 694, 717, 827

In patients with a bioprosthetic valve in the aortic position, ACCP recommends aspirin or warfarin for the
first 3 months following valve insertion.827Follow-up long-term therapy recommended to protect against
thromboembolism in patients with bioprosthetic heart valves who are in sinus rhythm and without risk
factors.827

May be added to therapy with a low molecular weight heparin or unfractionated heparin in pregnant
women with prosthetic heart valves who are at high risk for thrombosis.845

Thrombosis Associated with Fontan Procedure

Has been used for prevention of thromboembolic complications following Fontan procedure (definitive
palliative surgical treatment for most congenital univentricular heart lesions) in children.662, 825
Antithrombotic therapy effective in <50% of patients and many prophylactic regimens in use; no
consensus on optimal regimen.662, 825

Pericarditis

Drug of choice for the management of pain associated with acute pericarditis following MI.635, 821

Kawasaki Disease

Treatment of Kawasaki disease; used in conjunction with immune globulin IV (IGIV).636, 637, 638, 662,
825

Complications of Pregnancy

Has been used alone or in combination with other drugs (e.g., heparin, corticosteroids, immune globulin)

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for prevention of complications of pregnancy (e.g., preeclampsia, pregnancy loss in women with a
history of antiphospholipid syndrome and recurrent fetal loss).594, 595, 596, 597, 599, 600, 601, 605, 626, 627,
628, 647, 648, 650, 651, 652, 653, 654, 705, 706, 707, 708, 709, 710, 711, 712, 713, 714, 715, 726, 817, 845, 857

Use in combination with subcutaneous low-dose unfractionated heparin or a low molecular weight
heparin suggested by ACCP in women with a congenital thrombophilic deficit and recurrent spontaneous
abortions, a second-trimester or later pregnancy loss, severe or recurrent preeclampsia, or abruption.845

Combined prophylactic therapy with low dosages of aspirin and unfractionated heparin considered the
regimen of choice in women with antiphospholipid syndrome and a history of multiple pregnancy losses,
followed by postpartum oral anticoagulation therapy.845 Combination prophylactic therapy with aspirin
and unfractionated or low molecular weight heparin followed by postpartum anticoagulation suggested in
women with antiphospholipid syndrome and a history of multiple pregnancy losses,preeclampsia,
intrauterine growth retardation, or abruption.845, 857 In women with antiphospholipid syndrome and no
prior venous thromboembolism or pregnancy loss, consider clinical surveillance alone or therapy with
low-dose unfractionated heparin, once-daily low molecular weight heparin, and/or low dosages of
aspirin.647, 652, 845, 857

Routine use of aspirin prophylaxis to reduce the incidence and severity of preeclampsia (even in patients
at increased risk of preeclampsia) generally not recommended; 634, 705, 706, 707, 712, 713, 715 can consider
prophylaxis in women with prior severe or early-onset preeclampsia, chronic hypertension, severe
diabetes, or moderate to severe renal disease.815, 816, 817 (See Pregnancy under Cautions.)

Prevention of Cancer

Limited data (observational studies) suggest that aspirin or other NSAIAs may reduce the risk of various
cancers (e.g., colorectal, breast, gastric cancer);864, 870, 871, 872, 873 such results generally not
confirmed in randomized controlled trials.864, 874, 875, 876

Regular use (e.g., daily) associated with a reduction in the risk of recurrent colorectal adenomas and
colorectal cancer in some studies.789, 790, 791, 792, 793, 794, 795, 796, 797, 798, 799, 800, 801, 802, 803, 804,
805, 806, 807, 808, 809, 810, 811, 812, 813, 814, 815 Beneficial effects of NSAIAs in reducing colorectal cancer
risk dissipate following discontinuance of such therapy. Preventive therapy with aspirin currently not
recommended because aspirin does not completely eliminate adenomas; aspirin therapy should not be
considered a replacement for colorectal cancer screening and surveillance.790, 793, 794, 795, 796, 814

Dosage and Administration

Administration

Administer orally; may administer rectally as suppositories in patients who cannot tolerate oral therapy.a

Do not use aspirin preparation if strong vinegar-like odor is present.a

Oral Administration
Usually administer orally with food or a full glass of water (240 mL).a, 836, m

Film-coated, extended-release, or enteric-coated may be associated with less GI irritation and/or

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symptomatic GI disturbances than uncoated tablets.a

Do not use delayed-release or extended-release tablets if rapid response is required.a

Swallow delayed-release and extended-release tablets whole; do not crush or chew.a

Prepare oral solution by dissolving 2 tablets for solution (Alka-Seltzer®) in 120 mL of water; ingest the
entire solution to ensure adequate dosing.838, 843, 844

Do not chew aspirin preparations for ≥7 days following tonsillectomy or oral surgery;841, 837 do not place
preparations directly on tooth or gum surface (possible tissue injury from prolonged contact).a

Rectal Administration
Do not administer aspirin tablets rectally.a

Dosage

When used for pain, fever, or inflammatory diseases, attempt to titrate to the lowest effective dosage.a

When used in anti-inflammatory dosages, development of tinnitus can be used as a sign of elevated
plasma salicylate concentrations (except in patients with high-frequency hearing impairment).a

Pediatric Patients
Dosage in children should be guided by body weight or body surface area.a, 841

Do not use in children and teenagers with varicella or influenza, unless directed by a clinician.841 (See
Contraindications under Cautions.)

Pain
Oral: Children 2-11 years of age: 1.5 g/m2 daily administered in 4-6 divided doses (maximum 2.5 g/m2
daily).a

>Dosage for Self-medication of Pain in Children <12 Years of Age841

Age Weight Oral Dosea
<3 years of age <14.5 kg Consult clinician
3-<4 years 14.5-16 kg 160 mg
4-<6 years 16-20.5 kg 240 mg
6-<9 years 20.5-30 kg 320 mg
9-<11 years 30-35 kg 320-400 mg
11 years 35-38 kg 320-480 mg
aDose may be given every 4 hours as necessary (up to 5 times in 24 hours).841

For self-medication in children ≥12 years of age, 325-650 mg every 4 hours (maximum 4 g daily) or 1 g
every 6 hours as necessary.836, e
For self-medication in children ≥12 years of age, 454 mg (as chewing gum pieces) every 4 hours as
necessary (maximum 3.632 g daily).837

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For self-medication in children ≥12 years of age, 650 mg (as highly buffered effervescent solution [Alka-
Seltzer® Original]) every 4 hours (maximum 2.6 g daily); alternatively, 1 g (Alka-Seltzer® Extra
Strength) every 6 hours (maximum 3.5 g daily).843, 844

>Rectal
Children 2-11 years of age: 1.5 g/m2 daily administered in 4-6 divided doses (maximum 2.5 g/m2 daily).a
Children ≥12 years of age: 325-650 mg every 4 hours as necessary (maximum 4 g daily).a

Fever
Oral: Children 2-11 years of age: 1.5 g/m2 daily administered in 4-6 divided doses (maximum 2.5 g/m2
daily).a

>Dosage for Self-medication of Fever in Children <12 Years of Age841

Age Weight Oral Doseb
<3 years of age <14.5 kg Consult physician
3-<4 years 14.5-16 kg 160 mg
4-<6 years 16-20.5 kg 240 mg
6-<9 years 20.5-30 kg 320 mg
9-<11 years 30-35 kg 320-400 mg
11 years 35-38 kg 320-480 mg
bDose may be given every 4 hours as necessary (up to 5 times in 24 hours).841

Children ≥12 years of age: 325-650 mg every 4 hours as necessary (maximum 4 g daily).a
For self-medication in children ≥12 years of age, 454 mg (as chewing gum pieces) every 4 hours as
necessary (maximum 3.632 g daily).837

>Rectal
Children 2-11 years of age: 1.5 g/m2 daily administered in 4-6 divided doses (maximum 2.5 g/m2 daily).a
Children ≥12 years of age: 325-650 mg every 4 hours as necessary (maximum 4 g daily).a

Inflammatory Diseases
>Juvenile Rheumatoid Arthritis
Oral: Initially, 90-130 mg/kg daily in divided doses.c, m Increase dosage as necessary for anti-
inflammatory efficacy; target plasma salicylate concentration is 150-300 mcg/mL.c, m Plasma
concentrations >200 mcg/mL associated with an increased incidence of toxicity.c, m

Rheumatic Fever
Oral: Initially, 90-130 mg/kg daily given in divided doses every 4-6 hours for up to 1-2 weeks for
maximal suppression of acute inflammation, followed by 60-70 mg/kg daily in divided doses for 1-6
weeks.a Adjust dosage based on response, tolerance, and plasma salicylate concentrations.a Gradually
withdraw over 1-2 weeks.a
Various regimens suggested depending on severity of initial manifestations.a Consult published protocols
for more information on specific dosages and schedules.a

Thrombosis

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>Acute Ischemic Stroke

Oral: 2-5 mg/kg daily suggested by ACCP following discontinuance of anticoagulant (e.g.,
unfractionated or LMW heparin, warfarin) therapy.825

>Blalock-Taussig Shunt
Oral: 5 mg/kg daily has been suggested following intraoperative heparin.825

>Fontan Procedure
Oral: 5 mg/kg daily has been suggested; optimal duration of therapy unknown.825

>Mechanical Prosthetic Heart Valves

Oral: 6-20 mg/kg daily in combination with oral anticoagulation for patients with lack of response to oral
anticoagulation or contraindication to full-dose oral anticoagulation suggested by ACCP.825

>Bioprosthetic Heart Valves

Oral: ACCP suggests same treatment as for adults825 (75-100 mg daily long term in those in sinus
rhythm).827

Kawasaki Disease
Oral: Initially, 80-100 mg/kg daily given in 4 equally divided doses (in combination with IVIG); initiate
within 10 days of onset of fever.636, 637, 638, 639, 640, 662, 825 May be necessary to monitor plasma
salicylate concentrations.636, 637, 638 When fever subsides, decrease dosage to 3-5 mg/kg once daily.636,
637, 638, 639, 640, 641

Continue indefinitely in those with coronary artery abnormalities;636, 637, 638 in the absence of such
abnormalities, continue for 6-8 weeks after initial onset of illness or until platelet count and erythrocyte
sedimentation rate return to normal.636, 637, 638, 662, 825

Adults
Pain
Oral: For self-medication, 325-650 mg every 4 hours (maximum 4 g daily) or 0.5-1 g every 6 hours as
necessary.836, e
For self-medication, 454 mg (as chewing gum pieces) every 4 hours as necessary (maximum 3.632 g
daily).837
Adults <60 years of age for self-medication: 650 mg (as a highly buffered effervescent solution [Alka-
Seltzer® Lemon-Lime or Original]) every 4 hours (maximum 2.6 g daily); alternatively, 1 g (Alka-
Seltzer® Extra Strength) every 6 hours (maximum 3.5 g daily).838, 843, 844
Adults ≥60 years of age for self-medication: 650 mg (as a highly buffered effervescent solution [Alka-
Seltzer® Lemon-Lime or Original]) every 4 hours (maximum 1.3 g daily); alternatively, 1 g (Alka-
Seltzer® Extra Strength) every 6 hours (maximum 1.5 g daily).838, 843, 844

>Rectal
325-650 mg every 4 hours as necessary (maximum 4 g daily).a

>Pain Associated with Migraine Headache

Oral: For self-medication, 500 mg (combined with acetaminophen 500 mg and caffeine 130 mg) as a
single dose.701

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Fever
Oral: 325-650 mg every 4 hours as necessary (maximum 4 g daily).a
For self-medication, 454 mg (as chewing gum pieces) every 4 hours as necessary (maximum 3.632 g
daily).837

>Rectal
325-650 mg every 4 hours as necessary (maximum 4 g daily).a

Inflammatory Diseases
>Rheumatoid Arthritis and Arthritis and Pleurisy of SLE
Oral: Initially, 3 g daily in divided doses.c, l, m Increase dosage as necessary for anti-inflammatory
efficacy; target plasma salicylate concentration is 150-300 mcg/mL.c, l, m Plasma concentrations >200
mcg/mL associated with an increased incidence of toxicity.c, l, m

>Osteoarthritis
Oral: Up to 3 g daily in divided doses.c, m

>Spondyloarthropathies
Oral: Up to 4 g daily in divided doses.c, m

Rheumatic Fever
Oral: Initially, 4.9-7.8 g daily in divided doses given for maximal suppression of acute inflammation.a
Adjust dosage based on response, tolerance, and plasma salicylate concentrations.a
Various regimens suggested depending on severity of initial manifestations.a Consult published protocols
for more information on specific dosages and schedules.a

TIAs and Acute Ischemic Stroke

>Secondary Prevention
Oral: 50-325 mg daily in patients who experienced a noncardioembolic stroke or TIA (i.e.,
atherothrombotic, lacunar, or cryptogenic stroke).a, m, 646, 691, 818
Alternatively, 25 mg (in combination with dipyridamole 200 mg) twice daily (morning and evening) or
clopidogrel (75 mg daily).738, 818
50-100 mg daily suggested by some clinicians for patients at moderate to high risk of bleeding
complications.818
Continue secondary prevention indefinitely.646, 691, 818, m

>Acute Treatment of Ischemic Stroke

Oral: 160-325 mg daily, initiated within 48 hours of stroke onset in patients who are not receiving
thrombolytic therapy and continued for up to 2-4 weeks;691, 699, 700, 818 then aspirin, dipyridamole and
aspirin, or clopidogrel for secondary prevention.646, 691, 699, 700, 818

CAD and MI
>Suspected AMI or ACS
Oral: 160-325 mg as soon as AMI or ACS is suspected (no later than 24 hours after symptom onset),
continued daily after MI.c, m, 579, 635, 646, 669, 765, 819, 820, 821, 862 (See CAD and MI: Secondary
Prevention, under Dosage and Administration.)
Consider adjunctive therapy with clopidogrel (e.g., 300-mg loading dose, then 75 mg daily) for acute ST-

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segment elevation MI, unless contraindicated.852, 853, 854, 855, 856, 862
75-325 mg daily initially for non-ST-segment elevation (NSTE) ACS also has been recommended.820

>Rectal
300 mg daily may be considered for patients with severe nausea, vomiting, or upper GI tract
disorders.821, 862

>Secondary Prevention
Oral: 75-325 or 75-162 mg once daily, continued indefinitely, has been recommended;c, 635, 646, 668, 669,
736, 740, 765, 775, 820, 821, 822, 823, 828, 867, 881, m current evidence suggests 75-81 mg daily sufficient for

long-term cardiovascular disease prevention and associated with less GI bleeding risk.s
75-162 mg (possibly 75-81 mg)s daily in combination with long-term (up to 4 years), moderate-intensity
(target INR: 2-3) oral anticoagulation recommended in post-MI patients where meticulous INR
monitoring standard and routinely accessible.820
≤100 mg (possibly 75-81 mg)s daily in combination with short-term (3 months), moderate-intensity
(target INR: 2-3) oral anticoagulation suggested in high-risk post-MI patients.820
≤100 mg (possibly 75-81 mg)s daily recommended in patients with history of aspirin-induced bleeding or
risk factors for bleeding.820

>Primary Prevention of MI
Oral: 75-162 mg once daily.669, 681, 682, 760, 765, 783, 820 Continue indefinitely, provided there are no
contraindications to aspirin.669, 681, 682, 760, 765, 783, 820

>Chronic Stable CAD

Oral: 75-162 mg daily; continue indefinitely.820 (See dosage for long-term cardiovascular disease
prevention under CAD and MI: Secondary Prevention, under Dosage and Administration.)
75-162 mg daily in combination with long-term clopidogrel therapy in patients with high risk of MI.820
(See dosage for long-term cardiovascular disease prevention under CAD and MI: Secondary Prevention,
under Dosage and Administration.)

>Angina
Oral: 75-325 mg once daily, continued indefinitely;740, 765, 775, 822, m 75-162 mg daily recommended by
ACCP for patients with chronic stable angina.820 (See dosage for long-term cardiovascular disease
prevention under CAD and MI: Secondary Prevention, under Dosage and Administration.)
Unstable angina: 75-325 mg (possibly 75-81 mg)s once daily, continued indefinitely.m (See dosage for
long-term cardiovascular disease prevention under CAD and MI: Secondary Prevention, under Dosage
and Administration.)

>PCI and Revascularization Procedures

Oral: PCI in adults who are already receiving aspirin: 75-325 mg initiated ≥2 hours before the procedure
(e.g., PTCA, stent placement) in conjunction with a thienopyridine derivative.646, 685, 686, 821, 824, 865,
867
PCI in patients not already receiving long-term aspirin therapy: 300-325 mg daily, initiated at least 2
hours, preferably 24 hours, prior to PCIm in conjunction with a thienopyridine derivative.824, 865, m
Following PCI and bare-metal stent placement: 325 mg daily for ≥1 month in conjunction with a
thienopyridine derivative; ideally, continue for ≤1 year in patients who are not at high risk for
bleeding.821, 824, 865, 867

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Following PCI and drug-eluting stent placement: 75-100 mg daily for ≥12 months in combination with a
thienopyridine derivative (e.g., clopidogrel 75 mg daily).824, 886
Following PCI for prevention of myocardial ischemic events in patients requiring other antithrombotic
agents (e.g., clopidogrel, warfarin):<100 mg (possibly 75-81 mg)s daily recommended.824, 878 (See
dosage for long-term cardiovascular disease prevention under CAD and MI: Secondary Prevention, under
Dosage and Administration.)
Brachytherapy for restenosis following PCI and stent implantation : 75-325 mg daily in combination
with clopidogrel (75 mg daily) suggested by ACC and AHA and other clinicians.
Continue indefinitely for secondary prevention of cardiovascular events.c, 646, 686, 824, 865, 867, 880, m
(See dosage for long-term cardiovascular disease prevention under CAD and MI: Secondary Prevention,
under Dosage and Administration.)
CABG: Some manufacturers recommend 325 mg daily, initiated 6 hours after surgery.c, m If bleeding
precludes earlier use, initiate as soon as possible thereafter .685, 768, 823
Saphenous vein CABG: 100-325 mg daily initiated within 48 hours after saphenous vein CABG
suggested by ACC and AHA.867, 885 75-325 mg daily initiated at 6 hours after surgery recommended by
ACCP.823
Internal mammary artery CABG: 75-162 mg daily, continued indefinitely, recommended by ACCP.823
(See dosage for long-term cardiovascular disease prevention under CAD and MI: Secondary Prevention,
under Dosage and Administration.)
Following CABG: Manufacturer recommends 325 mg daily for 1 year after CABG.m ACCP recommend
75-162 mg daily continued indefinitely.646, 685, 821, 823 ACC and AHA recommend >162 mg daily for
<1 year following saphenous vein CABG.867 (See dosage for long-term cardiovascular disease
prevention under CAD and MI: Secondary Prevention, under Dosage and Administration.)
Carotid endarterectomy: ACCP recommends 75-325 mg daily initiated preoperatively and continued
indefinitely.690, 828 Manufacturer recommends 80 mg daily to 650 mg twice daily initiated preoperatively
and continued indefinitely.m (See dosage for long-term cardiovascular disease prevention under CAD and
MI: Secondary Prevention, under Dosage and Administration.)
Lower-extremity balloon angioplasty with or without stenting: 75-162 mg daily continued
indefinitely.690, 828 (See dosage for long-term cardiovascular disease prevention under CAD and MI:
Secondary Prevention, under Dosage and Administration.)

Atrial Fibrillation/Flutter
Oral: Patients at high risk for stroke who decline or have contraindications to oral anticoagulation: 325
mg daily.744, 773, 776, 826
Intermediate risk for stroke: 325 mg daily or warfarin.826
≥60 years of age and no other risk factors: 325 mg daily.773
Low risk for stroke: 325 mg daily.744, 747, 748, 749, 767, 773, 774, 776, 826

Mitral Valve Prolapse

Oral: 50-162 mg daily long-term in those with unexplained TIAs.764, 827

Thrombosis in Other Arteries and Arteriovenous Communications

>Carotid Stenosis
Oral: 75-162 mg daily indefinitely recommended by ACCP for patients who are not surgical
candidates.828 (See dosage for long-term cardiovascular disease prevention under CAD and MI:
Secondary Prevention, under Dosage and Administration.)

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>Ischemic Events in Peripheral Arterial Occlusive Disease

Oral: 75-325 mg daily.690, 769, 828 Continue indefinitely.690, 769, 828 (See dosage for long-term
cardiovascular disease prevention under CAD and MI: Secondary Prevention, under Dosage and
Administration.)

>Vascular Grafts
Oral: 75-325 mg daily in patients undergoing prosthetic infrainguinal bypass; initiate preoperatively.690,
769, 828

Use in combination with oral anticoagulation in patients at high risk of bypass occlusion or limb loss.690,
769, 828

Continue life-long aspirin prophylaxis.690, 769, 828 (See dosage for long-term cardiovascular disease
prevention under CAD and MI: Secondary Prevention, under Dosage and Administration.)

Prosthetic Heart Valves

>Mechanical Prosthetic Heart Valves
Oral: Optimal regimen not established.692 Consider low dosages (75-100 mg daily) of aspirin in
combination with oral anticoagulation for patients at increased risk of thromboembolism (e.g., those with
history of embolic event, atrial fibrillation, CHD, large left atrium, endocardial damage, low ejection
fraction, caged ball or caged disk valve, >1 mechanical heart valve, mechanical valve in mitral
position).692, 694, 717, 827
75-100 mg daily in combination with oral anticoagulation for patients who develop systemic embolism
with oral anticoagulation alone.692, 777, 827 Increase dosage to 325 mg daily and/or titrate warfarin
anticoagulation to a higher INR in patients who develop systemic embolism despite receiving combined
therapy with oral anticoagulation and low dosages of aspirin.741
80-100 mg daily recommended for patients with prosthetic heart valves in whom oral anticoagulation
must be discontinued.827
Consult specialized references for additional information.692, 694, 717

>Bioprosthetic Heart Valves

Oral: Bioprosthetic valve in the aortic position: 80-100 mg daily recommended for the first 3 months
following valve insertion.827
75-100 mg daily long term for those in sinus rhythm with no other risk factors for thromboembolism.692,
694, 744, 827

Pericarditis
>Acute Pericarditis Following MI
Oral: 162-325 mg daily.635, 821 Higher dosages (e.g., 650 mg every 4-6 hours) may be required.635, 821

Complications of Pregnancy
Oral: Congenital thrombophilic defect and recurrent spontaneous abortions, second-trimester or later
pregnancy loss, severe or recurrent preeclampsia, or abruption: 75-162 mg daily combined with heparin
or a low molecular weight heparin followed by postpartum anticoagulation (e.g., with warfarin).845
Antiphospholipid syndrome and a history of multiple pregnancy losses, preeclampsia, intrauterine
growth retardation, or abruption: 75-162 mg daily in combination with unfractionated or low molecular
weight heparin, followed by postpartum oral anticoagulation suggested.845
Presence of antiphospholipid antibodies and no prior venous thromboembolic events or pregnancy loss:
75-162 mg daily suggested.647, 652, 762, 845, 857

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Prescribing Limits

Pediatric Patients
Pain
Oral: Children 2-11 years of age: Maximum 2.5 g/m2 daily.a
Children ≥12 years of age: Maximum 4 g daily.836 Maximum 2.6 g as highly buffered effervescent
solution (Alka-Seltzer® Original) or 3.5 g (Alka-Seltzer® Extra Strength) in 24 hours.843, 844
For self-medication, do not exceed recommended daily dosage.841 Treatment duration for self-medication
for pain: ≤ 5 days.841 (See Advice to Patients.) Treatment duration for self-medication of sore throat pain
using chewing gum: ≤2 days.837

>Rectal
Children 2-11 years of age: Maximum 2.5 g/m2 daily.a
Children ≥12 years of age: Maximum 4 g daily.a

Fever
Oral: Children 2-11 years of age: Maximum 2.5 g/m2 daily.a
Children ≥12 years of age: Maximum 4 g daily.836
For self-medication, do not exceed recommended daily dosage.841 Treatment duration for self-
medication: <3 days.841 (See Advice to Patients.)

>Rectal
Children 2-11 years of age: Maximum 2.5 g/m2 daily.a
Children ≥12 years of age: Maximum 4 g daily.a

Adults
Pain
Oral: Maximum 4 g daily.a Treatment duration for self-medication for pain: ≤10 days.841 Aspirin
chewing gum should not be used for self-medication of sore throat pain for longer than 2 days.837 (See
Advice to Patients.)
Adults <60 years of age taking highly buffered effervescent solutions: Maximum 2.6 g (Alka-
Seltzer®Lemon-lime or Original) or 3.5 g (Alka-Seltzer® Extra Strength) in 24 hours.838, 843, 844
Adults ≥60 years of age taking highly buffered effervescent solutions: Maximum 1.3 g (Alka-
Seltzer®Lemon-lime or Original) or 1.5 g (Alka-Seltzer® Extra Strength) in 24 hours.838, 843, 844

>Rectal
Maximum 4 g daily.a

>Pain Associated with Migraine Headache

Oral: For self-medication, maximum 500 mg (in combination with acetaminophen 500 mg and caffeine
130 mg) in 24 hours.701

Fever
>Oral or Rectal
Maximum 4 g daily.a

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Special Populations

Geriatric Patients
Highly buffered effervescent solution: Maximum 1.3 g (Alka-Seltzer®Lemon-Lime or Original) or 1.5 g
(Alka-Seltzer® Extra Strength) in 24 hours.838, 843, 844

Cautions

Contraindications

• Known hypersensitivity to aspirin or any ingredient in the formulation.c, m

• History of asthma, urticaria, or other sensitivity reaction precipitated by other NSAIAs.c, m
• Syndrome of asthma, rhinitis, and nasal polyps.c
• Children or adolescents with viral infections (with or without fever) because of the possibility that the
infection may be one associated with an increased risk of Reye's syndrome.c, m (See Pediatric Use
under Cautions.)

Warnings/Precautions

Warnings
Alcohol
Long-term heavy alcohol use (≥3 alcoholic beverages daily) associated with an increased risk of aspirin-
induced bleeding.c, j, m (See Advice to Patients.)

Hematologic Effects
Inhibits platelet aggregation and may prolong bleeding time.c, m These effects may be particularly
important in patients with inherited (e.g., hemophilia) or acquired (e.g., liver disease, vitamin K
deficiency) bleeding disorders.c, m

Because of the increased risk of bleeding, avoid aspirin-containing chewing gum tablets or gargles for ≥1
week after tonsillectomy or oral surgery.h

GI Effects
Serious GI toxicity (e.g., bleeding, ulceration, perforation) can occur with or without warning symptoms.c
Increased risk in those with a history of GI bleeding or ulceration, geriatric patients, those receiving an
anticoagulant, receiving prolonged therapy, taking multiple NSAIAs concomitantly, and consuming ≥3
alcohol-containing beverages daily.j

Avoid in patients with active peptic ulcer disease; can cause gastric mucosal irritation and bleeding.c, m

Thrombosis Associated with Drug-eluting Stents

Stent thrombosis with potentially fatal sequelae, particularly with drug-eluting stents (DES),886, 890, 891
associated with premature discontinuance (<12 months) of dual-drug therapy with a thienopyridine
derivative and aspirin.886, 890, 891, 892, 893, 894, 895, 896, 897, 898, 899, 900 (See Percutaneous Coronary
Intervention and Revascularization Procedures under Uses.) For non-elective procedures that mandate
premature discontinuance of thienopyridine-derivative therapy, continue aspirin therapy if at all
possible.886 Restart thienopyridine therapy as soon as possible after the procedure.886 (See Advice to
Patients.)

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Sensitivity Reactions
Anaphylactoid reactions, severe urticaria, angioedema, or bronchospasm reported.836, c, h, m

Immediate medical intervention and discontinuance for anaphylaxis.836

Contraindicated in patients with syndrome of asthma, rhinitis, and nasal polyps;c, m caution in patients
with asthma.c

General Precautions
Sodium Content
Avoid highly buffered aspirin preparations in patients with CHF, renal failure, or other conditions in
which high sodium content would be harmful.c, m

Individuals with Phenylketonuria

Some preparations contain aspartame (NutraSweet®), which is metabolized in the GI tract to
phenylalanine.a, 838

Use of Fixed Combinations

When aspirin is used in fixed combination with other agents, consider the cautions, precautions, and
contraindications associated with the other agent(s).a

Specific Populations
Pregnancy
Category C (Category D in third trimester).

Use only if clearly needed.c, m Avoid use in the third trimester because of possible premature closure of
the ductus arteriosus.c, m Avoid 1 week prior to and during labor and delivery; aspirin use prior to and
during labor associated with excessive blood loss at delivery.c, m

Maternal and fetal hemorrhagic complications observed with maternal ingestion of large doses (e.g., 12-
15 g daily) of aspirin594, 595, 597, 611, 612 generally have not been observed in studies in which low doses
(60-150 mg daily) of the drug were used for prevention of complications of pregnancy .594, 595, 596, 597,
598, 599, 600, 601, 605, 626, 627, 629, 630, 631, 632, 647

Lactation
Distributed into milk; use not recommended.c, m High doses may result in adverse effects (rash, platelet
abnormalities, bleeding) in nursing infants.c, m

Pediatric Use
Dosing recommendations for juvenile rheumatoid arthritis based on well controlled clinical studies.c, m
High dosages that result in plasma concentrations >200 mcg/mL associated with an increased incidence
of toxicity.c, m

Use in children with varicella infection or influenza-like illnesses reportedly is associated with an
increased risk of developing Reye's syndrome.166, 167, 168, 169, 468, 538, 549, 638 US Surgeon General,
AAP Committee on Infectious Diseases, FDA, and other authorities advise that salicylates not be used in

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children and teenagers with varicella or influenza, unless directed by a clinician.466, 467, 554, 638
Generally avoid salicylates in children and teenagers with suspected varicella or influenza and during
presumed outbreaks of influenza, since accurate diagnosis of these diseases may be impossible during the
prodromal period;466 use of salicylates in the management of viral infections in children or adolescents is
contraindicated, since the infection may be one associated with an increased risk of Reye's syndrome.646,
m

Use with caution in pediatric patients who are dehydrated (increased susceptibility to salicylate
intoxication).h

Safety and efficacy of aspirin in fixed combination with extended-release dipyridamole not
established.738

Risk of overdosage and toxicity (including death) in children <2 years of age receiving preparations
containing antihistamines, cough suppressants, expectorants, and nasal decongestants alone or in
combination for relief of symptoms of upper respiratory tract infection.b, d Limited evidence of efficacy
for these preparations in this age group; appropriate dosages not established.b Use such preparations in
children <2 years of age with caution and only as directed by clinician.b, d Clinicians should ask
caregivers about use of OTC cough/cold preparations to avoid overdosage.b

Hepatic Impairment
Avoid in patients with severe hepatic impairment.c, m

Renal Impairment
Avoid in patients with GFR <10 mL/minute.c, m

Common Adverse Effects

Minor upper GI symptoms (dyspepsia).c

Interactions

Protein-bound Drugs

Potential for salicylate to be displaced from binding sites by, or to displace from binding sites, other
protein-bound drugs.h, m Aspirin acetylates serum albumin, which may alter binding of other drugs to the
protein.a

Specific Drugs

Drug Interaction Comments

Reduced BP response to ACE

inhibitorsc
ACE inhibitors Possible attenuation of Monitor BPc
hemodynamic actions of ACE
inhibitors in patients with CHFh
Reduced hyponatremic effect of

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ACE inhibitorsc, m
Drugs that decrease urine pH
Acidifying agents may decrease salicylate
excretionh

Alcohol Increased risk of bleedingc, m

(See Advice to Patients.)
Monitor plasma salicylate concentrations in
Alkalinizing Drugs that increase urine pH may
patients receiving high-dose aspirin therapy if
agents increase salicylate excretionh
antacids are initiated or discontinuedh
Increased risk of bleedingc, m
May displace warfarin from
Anticoagulants
(warfarin, heparin)
protein-binding sites, leading to Use with cautionh
prolongation of PT and bleeding
timec, m
May displace phenytoin from
binding sites; possible decrease
in total plasma phenytoin
concentrations, with increased
free fractionc, m Monitor patients receiving aspirin with valproic
Anticonvulsants May displace valproic acid from
acidh
binding sites; possible increase in
free plasma valproic acid
concentrations;c, h, m possible
increased risk of bleedingh
Antidiabetic drugs Potential for increased
Monitor closelyh
(sulfonylureas) hypoglycemic effectc, m
Reduced BP response to β-
β-adrenergic adrenergic blocking agents c, m
blocking agents Potential for salt and fluid Monitor BPc
retentionm
Increased risk of salicylate
Carbonic
toxicityh Avoid concomitant use in patients receiving high-
anhydrase
Increased plasma acetazolamide
inhibitors
concentrations; increased risk of dose aspirinh
(acetazolamide)
acetazolamide toxicityc, m
Decreased plasma salicylate
Corticosteroids Monitor for adverse effects of either drugh
concentrationsh
Possible reduced natriuretic
Diuretics
effectc

Increased plasma methotrexate

concentrationsh
Methotrexate Inhibition of renal clearance of Monitor for methotrexate toxicityh
methotrexate leading to bone
marrow toxicity, especially in
geriatric patients or patients with

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renal impairmentm
Increased risk of bleeding, GI
ulceration, decreased renal
function, or other
complications861, m, p, q, r
No consistent evidence that low-
dose aspirin mitigates increased
risk of serious cardiovascular Concomitant use not recommendedc, m, p, q, r
events associated with Pharmacokinetic interactions unlikely to be
NSAIAs861, r clinically importanth
Pharmacokinetic interactions Immediate-release aspirin: Administer a single
dose of ibuprofen 400 mg for self-medication≥8
with many NSAIAsh hours before or ≥30 minutes after administration
Antagonism (ibuprofen,
naproxen) of the irreversible of aspirin858, 859
platelet-aggregation inhibitory Enteric-coated low-dose aspirin: No
effect of aspirin; may limit the recommendations regarding timing of
NSAIAs
cardioprotective effects of administration with single dose of ibuprofen858,
859
aspirin788, 858, 859, 860
Minimal risk of attenuating Consider use of alternative analgesics that do not
effects of low-dose aspirin with interfere with antiplatelet effect of low-dose
occasional use of ibuprofen858 aspirin (e.g., acetaminophen, opiates) for patients
Not known whether ketoprofen at high risk of cardiovascular events858, 859
interferes with the antiplatelet Concomitant use with prescription NSAIAs not
effect of aspirin858, 859 recommended because of potential for increased
Decreased peak plasma adverse effects861
concentration and AUC of
diclofenac;p, q limited data
indicate that diclofenac does not
inhibit antiplatelet effect of
aspirin788
Possible prevention or reduction
Pyrazinamide of hyperuricemia associated with
pyrazinamideh
Decreased oral absorption of
tetracyclines when administered Administer preparations containing divalent or
Tetracycline with aspirin preparations trivalent cations (Bufferin®) 1 hr before or after
containing divalent or trivalent tetracyclineh
cations (Bufferin®)h
Additive reduction in mortality
reported in patients with AMI
receiving aspirin in low dosages
Thrombolytic and thrombolytic agents Used for therapeutic effect579, 580, 581, 582, 583,
agents 584, 585, 586, 587, 588, 589, 590
(streptokinase, alteplase)579, 580,
581, 582, 583, 584, 585, 586, 587, 588,
589, 590

Uricosuric agents
(probenecid, Reduced uricosuric effect of

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sulfinpyrazone) uricosuric agentsc, m

Manufacturer of varicella virus vaccine live
recommends that individuals who receive the
vaccine avoid use of salicylates for 6 weeks
following vaccination756
For children who are receiving long-term
salicylate therapy, AAP suggests weighing
Varicella virus Theoretical possibility of Reye's
theoretical risks of vaccination against known
vaccine live syndrome638
risks of wild-type virus;638 ACIP states that
children who have rheumatoid arthritis or other
conditions requiring therapeutic salicylate therapy
probably should receive varicella virus vaccine
live in conjunction with subsequent close
monitoring757

Pharmacokinetics

Absorption

Bioavailability
Well absorbed following oral administration.h, mRapidly metabolized to salicylic acid; plasma aspirin
concentrations are undetectable 1-2 hours after administration.m Peak plasma salicylic acid
concentrations attained within 1-2 hours following administration of uncoated tablets.m

Slowly and variably absorbed following rectal administration.h

Onset
Single oral doses of rapidly absorbed preparations: 30 minutes for analgesic and antipyretic effects.h

Rectal suppositories: 1-2 hours for antipyretic effects.h

Continuous oral therapy: 1-4 days for anti-inflammatory effect.h

Food
Food decreases rate but not extent of absorption; peak plasma concentrations of aspirin and salicylate
may be decreased.h

Plasma Concentrations
Plasma salicylate concentrations of 30-100 mcg/mL produce analgesia and antipyresis; the concentration
required for anti-inflammatory effect is 150-300 mcg/mL; toxicity noted at 300-350 mcg/mL.h

Steady-state plasma salicylate concentrations increase more than proportionally with increasing doses as
a result of capacity-limiting processes.h

Special Populations
During the febrile phase of Kawasaki disease, oral absorption may be impaired or highly variable.h

Distribution

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Extent
Widely distributed; aspirin and salicylate distribute into synovial fluid.a, h, m Crosses placenta and
distributed into milk.m

Plasma Protein Binding

Aspirin: 33%.a

Salicylate: 90-95% bound at plasma salicylate concentrations <100 mcg/mL; 70-85% bound at
concentrations of 100-400 mcg/mL; 25-60% bound at concentrations >400 mcg/mL.h, m

Elimination

Metabolism
Partially hydrolyzed to salicylate by esterases in the GI mucosa.a Unhydrolyzed aspirin subsequently
undergoes hydrolysis by esterases mainly in the liver but also in plasma, erythrocytes, and synovial
fluid.a

Salicylate is metabolized in the liver by the microsomal enzyme system.h

Elimination Route
Excreted in urine via glomerular filtration and renal tubular reabsorption as salicylate and its
metabolites.h Urinary excretion of salicylate is pH dependent; as urine pH increases from 5 to 8, urinary
excretion of salicylate is greatly increased.h

Half-life
Aspirin: 15-20 minutes.a

Half-life of salicylate increases with increasing plasma salicylate concentrations.h, m

Salicylate: 2-3 hours when aspirin administered in low doses (325 mg).h

Salicylate: 15-30 hours when aspirin administered in higher dosages.h

Special Populations
Salicylate and its metabolites readily removed by hemodialysis and, to a lesser extent, by peritoneal
dialysis.h

Stability

Storage

Oral
Capsules
Aspirin in fixed-combination with extended-release dipyridamole: 25°C (may be exposed to 15-30°C).738
Protect from excessive moisture.738

Gum

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15-25°C; protect from excessive moisture.837

Tablets
Room temperature (Bayer products, excluding Alka-Seltzer® products);839, 840, 841, 842, m avoid high
humidity and excessive heat (40°C).840

15-30°C (Easprin®).l

20-25°C (Anacin® Extra Strength); protect from moisture.836

Protect from excessive heat (Alka-Seltzer® products).838, 843, 844

Rectal
Suppositories
2-15°C.a

Actions

• Inhibits COX-1 and COX-2 activity.677

• Pharmacologic actions similar to those of prototypical NSAIAs; exhibits anti-inflammatory, analgesic,
and antipyretic activity.c
• Irreversibly acetylates and inactivates COX-1 in platelets.677
• The existence of 2 COX isoenzymes with different aspirin sensitivities and extremely different recovery
rates of their COX activity following inactivation by aspirin at least partially explains the different
dosage requirements and durations of aspirin effects on platelet function versus the drug's analgesic
and anti-inflammatory effects.677
• Effects on urinary excretion of uric acid are dose related; large dosages (e.g., 1.3 g 4 times daily)
enhance urinary excretion and decrease serum concentrations of uric acid, intermediate dosages (e.g.,
650 mg to 1 g 3 times daily) usually do not alter uric acid excretion, and low dosages (e.g., <325 mg 3
times daily) inhibit excretion and may increase serum uric acid concentrations.h

Advice to Patients

• When used for self-medication, importance of reading the product labeling.836, 841, e, 837, 838, 843, 844
• When used for self-medication, importance of asking clinician whether to use aspirin or another
analgesic if alcohol consumption is ≥3 alcohol-containing drinks per day.836, e, 837, 838, 841, 843, 844
• Importance of informing patients about risk of bleeding associated with chronic, heavy alcohol use
while taking aspirin.j, m
• When used for self-medication in children, importance of basing the dose on the child's weight or body
surface area.841
• In patients with drug-eluting stents (DES) receiving aspirin in combination with clopidogrel or
ticlopidine, importance of not discontinuing antiplatelet therapy without consulting cardiologist, even
if instructed to do so by other health-care professional (e.g., dentist).886
• Importance of not using aspirin for chicken pox or flu symptoms in children or adolescents without
consulting a clinician.836, e, 837, 838, 841, 843, 844
• Patients receiving anticoagulants and those with asthma, gout, diabetes, arthritis, peptic ulcers, bleeding
problems, or stomach problems that persist or recur should consult a clinician before using aspirin for

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self-medication.836, e, 837, 838, 841, 843, 844

• Discontinue and consult clinician if pain or fever persists or progresses, new symptoms occur, redness
or swelling is present in a painful area, or ringing in the ears or loss of hearing occurs.836, e, 837, 838,
841, 843, 844

• Risk of GI bleeding or ulceration, particularly with prolonged therapy,c, j, m and concomitant therapy
with another NSAIA.j
• Risk of anaphylactoid and other sensitivity reactions.c
• Importance of notifying clinician if signs and symptoms of GI ulceration or bleeding or rash develop.c
• Importance of seeking immediate medical attention if an anaphylactic reaction occurs.c
• Importance of women informing clinicians if they are or plan to become pregnant or to breast-feed.c
Importance of avoiding aspirin in late pregnancy (third trimester) and during labor and delivery.c
• Importance of informing clinicians of existing or contemplated concomitant therapy, including
prescription and OTC drugs.c
• Importance of informing patients of other important precautionary information.c (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some
individuals; consult specific product labeling for details.

Aspirin
Routes Dosage Forms Strengths Brand Names Manufacturer
Pieces, chewing
Oral 227 mg Aspergum® Heritage, Schering-Plough
gum
Aspirin Adult Low
Tablets 81 mg Geri-Care, Magno-Humphries
Strength
Aspirin Low dose Basic Vitamins
325 mg* Norwich® Aspirin Chattem
®
500 mg* Norwich Aspirin Chattem
Maximum Strength
650 mg*
Tablets, chewable 81 mg* Bayer® Aspirin Children's Bayer
AmerisourceBergen, Cardinal Health,
Chain Drug Marketing, Eckerd, Ivax,
Aspirin Children's
Major, PDK, Prime Marketing,
Qualitest, Rugby, URL
Aspirin for Children Geri-Care
St. Joseph® Aspirin Low
Strength Adult McNeil
Chewable®
Tablets, delayed-
release (enteric- 81 mg* Bayer® Aspirin Regimen Bayer
coated) Adult Low Strength

Ecotrin® Adult Low GlaxoSmithKline

Strength (with propylene

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glycol)
Halfprin® Kramer
Aspirin Adult Low
AmeriscourceBergen, Ivax
Strength
Aspirin Enteric Coated Advance, Time-Cap
Aspirin Low Dose Qualitest
Aspirin Regimen PDK
Aspirin Regimen Low
Cardinal Health
Strength
St. Joseph Pain Reliever
McNeil
Adult
162 mg Halfprin® Kramer
Aspirin Regimen Bayer®
325 mg* Regular Strength Caplets® Bayer
(with propylene glycol)
Ecotrin® Regular Strength GlaxoSmithKline
(with propylene glycol)
Genacote® Ivax
Aspirin Enteric Coated
Time-Cap
Tablets
Aspirin for Arthritis Cardinal Health
Ecotrin® Maximum
500 mg* Strength (with propylene GlaxoSmithKline
glycol)
Aspirin Enteric Coated
Time-Cap
Tablets
Aspirin Extra Strength Medicine Shoppe
Aspirin Maximum
Chain Drug Marketing
Strength
Aspirin Enteric Coated
650 mg* Time-Cap, United Research
Tablets
975 mg Easprin® Rosedale
Aspirin Enteric Coated
Time-Cap
Tablets
Tablets,
800 mg ZORprin® Par
extended-release
Tablets, film- Genuine Bayer®
325 mg* Bayer
coated AspirinTablets®
Aspirin Lite Coated AmerisourceBergen
Aspirin Micro Coated
Time-Cap
Tablets
Aspirin Microthin Coating Cardinal Health

Extra Strength Bayer®

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®
500 mg Aspirin Caplets (with Bayer
propylene glycol)
Rectal Suppositories 60 mg* Aspirin Suppositories Consolidated Midland
120 mg* Aspirin Suppositories Consolidated Midland
200 mg* Aspirin Suppositories Consolidated Midland
300 mg*
Aspirin Suppositories Consolidated Midland
600 mg*
Aspirin Suppositories Consolidated Midland
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary)
name

Aspirin with Buffers

Dosage
Routes Strengths Brand Names Manufacturer
Forms
Tablets,
325 mg with
Oral enteric-
buffers Ascriptin® Enteric Regular Strength Novartis
coated
Tablets, 81 mg with Women's Bayer® Aspirin Plus Calcium Caplets® (with Bayer
film-coated buffers calcium carbonate and crospovidone)
325 mg with
buffers Ascriptin® Regular Strength Novartis

Ascriptin® Arthritis Pain Caplets® Novartis

Bufferin® Tablets (with povidone and propylene Novartis
glycol)
500 mg with
buffers Ascriptin® Maximum Strength Caplets® Novartis

Extra Strength Bayer® Plus Caplets® (with calcium Bayer

carbonate and propylene glycol)
Bufferin® Extra Strength Caplets® (with povidone and Novartis
propylene glycol)
Bufferin® Extra Strength (with povidone and Novartis
propylene glycol)

Tablets, for Alka-Seltzer® Effervescent Pain Reliever and Antacid

325 mg (combination) (with citric acid 1 g and sodium Bayer
solution
bicarbonate 1.916 g)
Alka-Seltzer® Lemon Lime Effervescent Pain Reliever
and Antacid (with aspartame citric acid 1 g and sodium Bayer
bicarbonate 1.7 g)
Alka-Seltzer® Extra Strength Effervescent Pain
500 mg Reliever and Antacid (with citric acid 1 g and sodium Bayer
bicarbonate 1.985 g)

Acetaminophen and Aspirin

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Dosage
Routes Strengths Brand Names Manufacturer
Forms

Oral
For 325 mg/packet Acetaminophen Goody's® Body Pain Formula GlaxoSmithKline
solution and Aspirin 500 mg/packet Powders (combination)

Acetaminophen, Aspirin, and Caffeine

Dosage
Routes Strengths Brand Names Manufacturer
Forms

For
260 mg/packet Acetaminophen, Goody's® Extra Strength
Oral Aspirin 520 mg/packet, and Headache Powders GlaxoSmithKline
solution
Caffeine 32.5 mg/packet (combination)
125 mg Acetaminophen,
Tablets Aspirin 240 mg, Caffeine 32 Gelpirin® (combination) Alra
mg, and buffers
130 mg Acetaminophen,
Aspirin 260 mg, and Caffeine Goody's®Tablets (combination) GlaxoSmithKline
16.25 mg (with povidone)
160 mg Acetaminophen,
Aspirin 230 mg, Caffeine 33
mg, and buffers
194 mg Acetaminophen, Vanquish® Caplets®
Aspirin 227 mg, Caffeine 33 (combination) (with buffers and Bayer
mg, and buffers propylene glycol)
Tablets, 250 mg Acetaminophen, Excedrin® Extra-Strength
film- Aspirin 250 mg, and Caffeine Caplets® (combination) (with Bristol-Myers
coated 65 mg povidone and propylene glycol)
Excedrin® Extra-Strength
Geltabs (combination) (with Bristol-Myers
povidone and propylene glycol)
Excedrin® Extra-Strength
Tablets (combination) (with Bristol-Myers
povidone and propylene glycol)
Excedrin® Migraine Caplets® Bristol-Myers
(combination) (with povidone Squibb
and propylene glycol)
Excedrin® Migraine Geltabs Bristol-Myers
(combination) (with povidone Squibb
and propylene glycol)
Excedrin® Migraine Tablets Bristol-Myers
(combination) (with povidone Squibb
and propylene glycol)

Aspirin and Codeine Phosphate (Co-codaprin)

Dosage
Routes Strengths Brand Names Manufacturer
Forms

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325 mg Aspirin and Codeine Aspirin and Codeine Phosphate IVAX, United
Oral Tablets
Phosphate 30 mg* Tablets (C-III) Research
325 mg Aspirin and Codeine Aspirin and Codeine Phosphate IVAX, United
Phosphate 60 mg* Tablets (C-III) Research
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary)
name

Oxycodone and Aspirin

Dosage
Routes Strengths Brand Names Manufacturer
Forms
2.25 mg Oxycodone Hydrochloride, Percodan®-Demi
Oral Tablets Oxycodone Terephthalate 0.19 mg, and (combination) (C-II; Endo
Aspirin 325 mg* scored)
4.5 mg Oxycodone Hydrochloride,
Oxycodone Terephthalate 0.38 mg, and Endodan® (combination) Endo
Aspirin 325 mg* (C-II)

Percodan® (combination) Endo

(C-II; scored)
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary)
name

Propoxyphene Hydrochloride, Aspirin, and Caffeine

Dosage
Routes Strengths Brand Names Manufacturer
Forms
Darvon® Compound
65 mg Propoxyphene Hydrochloride, ®
Oral Capsules aaiPharma
Aspirin 389 mg, and Caffeine 32.4 mg* Pulvules (combination) (C-
IV)
PC-CAP® (combination) (C- Alra
IV)
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary)
name

Other Aspirin Combinations

Routes Dosage Forms Strengths Brand Names Manufacturer
®
325 mg with Butalbital 50 Fiorinal (combination)
Oral Capsules Watson
mg and Caffeine 40 mg* (C-III; with benzyl
alcohol and parabens)
Lanorinal (combination) Lannett
Aspirin and Caffeine with
Actavis
Butalbital
Butalbital, Aspirin, and
West Ward
Caffeine
®
325 mg with Butalbital 50 Fiorinal with Codeine
mg, Caffeine 40 mg, and (combination) (C-III; with Watson
Codeine Phosphate 30 mg benzyl alcohol and
parabens)

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Ascomp® with Codeine Breckenridge

(combination)
Butalbital, Aspirin.
Anabolic, Stevens,
Caffeine, and Codeine
Watson
Phosphate
356.4 mg with Caffeine 30
mg and Dihydrocodeine Synalgos®-DC Leitner
Bitartrate 16 mg (combination) (C-III)
Capsules, extended-
release core
25 mg with Dipyridamole Aggrenox® (combination) Boehringer
200 mg (with povidone) Ingelheim
(dipyridamole only)
650 mg/packet with
For solution
Caffeine 33.3 mg/packet BC® Powder GlaxoSmith Kline
and Salicylamide 195 (combination)
mg/packet
650 mg/packet with
Caffeine 32 mg/packet and Stanback® Powder GlaxoSmithKline
Salicylamide 200 (combination)
mg/packet
742 mg/packet with
Caffeine 38 mg/packet and BC® Powder Arthritis GlaxoSmithKline
Salicylamide 222 Strength (combination)
mg/packet
325 mg with Butalbital 50 Butal Compound
Tablets Sandoz
mg and Caffeine 40 mg* (combination)
Fortabs® (combination) United Research
(C-III)
325 mg with Carisoprodol Consolidated
Carisoprodol Compound
200 mg Midland
Soma® Compound Medpointe
(combination)
325 mg with Carisoprodol
200 mg, and Codeine Soma® Compound with MedPointe
Phosphate 16 mg Codeine (combination)
325 mg with Meprobamate Equagesic® (combination) Leitner
200 mg (C-IV;scored)
Micrainin® (combination) Wallace
(C-IV)
385 mg with Caffeine 30
mg, and Orphenadrine Norgesic® (combination) 3M
Citrate 25 mg (with povidone)
Orphenadrine Citrate,
Aspirin, and Caffeine Sandoz
Tablets
400 mg with Caffeine 32 Lee
P-A-C® Analgesic
mg Pharmaceuticals
(combination) (with

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tartrazine)
500 mg with Hydrocodone Damason-P®
Mason
Bitartrate 5 mg (combination) (C-IV)
770 mg with Caffeine 60 Norgesic® Forte
mg, and Orphenadrine (combination) (with 3M
Citrate 50 mg povidone; scored)
Orphenadrine Citrate,
Aspirin, and Caffeine Sandoz
Tablets
400 mg with Caffeine 32 Anacin® Caplets®
Tablets, film-coated Wyeth
mg (combination)
Anacin® Tablets Wyeth
(combination)
421 mg with Caffeine 32 Lee
mg and buffers Cope® (combination) Pharmaceuticals
500 mg with Caffeine 32 Anacin® Maximum Wyeth
mg Strength (combination)
Extra Strength Bayer
500 mg with Caffeine 32.5
Back and Body Pain (with Bayer
mg
propylene glycol)
500 mg with Caffeine 65 Alka Seltzer Morning
Tablets, for solution Bayer
mg Relief (combination)
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary)
name

Aspirin is also commercially available in combination with other drugs such as analgesics,
antihistamines, antimuscarinics, antitussives, barbiturates, decongestants, and expectorants.

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing
information was updated 03/2011. For the most current and up-to-date pricing information, please visit
www.drugstore.com. Actual costs to patients will vary depending on the use of specific retail or mail-
order locations and health insurance copays.

Aggrenox 25-200MG 12-hr Capsules (BOEHRINGER INGELHEIM): 60/$195.99 or 180/$559.95

Aspirin 325MG Tablets (RUGBY): 100/$11.99 or 200/$13.98

Aspirin 81MG Chewable Tablets (RUGBY): 36/$11.99 or 72/$13.98

Aspirin EC 325MG Enteric-coated Tablets (QUALITEST): 1400/$45.99 or 4200/$135.97

Aspirin EC Low Dose 81MG Enteric-coated Tablets (QUALITEST): 1000/$45.99 or 3000/$129.97

Butalbital-ASA-Caffeine 50-325-40MG Capsules (LANNETT): 30/$25.99 or 90/$72.97

Butalbital-Aspirin-Caffeine 50-325-40MG Tablets (WEST-WARD): 30/$19.99 or 90/$29.97

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Carisoprodol-Aspirin 200-325MG Tablets (SANDOZ): 30/$65.99 or 90/$169.96

Carisoprodol-Aspirin-Codeine 200-325-16MG Tablets (SANDOZ): 30/$83.37 or 90/$240.03

Fiorinal 50-325-40MG Capsules (WATSON LABS): 100/$178.6 or 200/$357.2

Percodan 4.5-0.38-325MG Tablets (ENDO PHARMACEUTICALS): 20/$39.59 or 30/$52.77

Soma Compound 200-325MG Tablets (MEDA PHARMACEUTICALS): 30/$139.99 or 90/$399.96

Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

Only references cited for selected revisions after 1984 are available electronically.

166. Centers for Disease Control. Reye syndrome—Ohio, Michigan. MMWR Morb Mortal Wkly Rep.
1980; 29:532-9.

167. Starko KM, Ray CG, Dominguez LB et al. Reye's syndrome and salicylate use. Pediatrics. 1980;
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168. Partin JS, Schubert WK, Partin JC et al. Serum salicylate concentrations in Reye's disease: a study
of 130 biopsy-proven cases. Lancet. 1982; 1:191-4. [IDIS 145169] [PubMed 6119559]

169. Centers for Disease Control. National surveillance for Reye syndrome, 1981—update, Reye
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[PubMed 6799770]

466. Committee on Infectious Diseases, American Academy of Pediatrics. Aspirin and Reye
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467. Centers for Disease Control. Surgeon General's advisory on the use of salicylates and Reye
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468. Waldman RJ, Hall WN, McGee H et al. Aspirin as a risk factor in Reye's syndrome. JAMA. 1982;
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470. Wilson JT, Brown RD. Reye syndrome and aspirin use: the role of prodromal illness severity in
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537. Remington PL, Rowley D, McGee H et al. Decreasing trends in Reye syndrome and aspirin use in
Michigan, 1979 to 1984. Pediatrics. 1986; 77:93-8. [PubMed 3940363]

538. Hurwitz ES, Barrett MJ, Bregman D et al. Public Health Service study on Reye's syndrome and

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549. Hurwitz ES, Barrett MJ, Bregman D et al. Public Health Service study of Reye's syndrome and
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550. Orlowski JP, Gillis J, Kilham HA. A catch in the Reye. Pediatrics. 1987; 80:638-42. [IDIS
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551. Barrett MJ, Hurwitz ES, Schonberger LB et al. Changing epidemiology of Reye syndrome in the
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553. Centers for Disease Control. Reye syndrome surveillance—United States, 1986. MMWR Morb
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554. Glen-Bott AM. Aspirin and Reye's syndrome: a reappraisal. Med Toxicol Adverse Drug Exp.
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555. Sweeney KR, Chapron DJ, Brandt JL et al. Toxic interaction between acetazolamide and
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556. Fitzgerald GA. Dipyridamole. N Engl J Med. 1987; 316:1247-57. [IDIS 229092] [PubMed
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557. Stein PD, Collins JJ, Kantrowitz A. American College of Chest Physicians and the National
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Chest. 1986; 89(Suppl):46-53S.

558. Hirsch J, Fuster V, Salzman E. American College of Chest Physicians and the National Heart,
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559. Chesebro JH, Steele PM, Fuster V. Platelet-inhibitor therapy in cardiovascular disease: effective
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560. Chesebro JE, Clements IP, Fuster V et al. A platelet-inhibitor drug trial in coronary-artery bypass
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561. Chesebro JH, Fuster V, Elverback LR et al. Effect of dipyridamole and aspirin on late vein-graft
patency after coronary bypass operations. N Engl J Med. 1984; 310:209-14. [IDIS 180466] [PubMed

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6361561]

562. Chesebro JH, Fuster V, Elverback LR. Dipyridamole and aspirin and patency of coronary bypass
grafts. N Engl J Med. 1984; 310:1534. [PubMed 6538932]

563. Brown BG, Cukingnan RA, DeRouen T et al. Improved graft patency in patients treated with
platelet-inhibiting therapy after coronary bypass surgery. Circulation. 1985; 72:138-46. [IDIS
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564. The American-Canadian Co-operative Study Group. Persantine aspirin trial in cerebral ischemia.
Part II: endpoint results. Stroke. 1985; 16:406-15. [PubMed 2860740]

565. The ESPS Study Group. The European stroke prevention study (ESPS): principal end-points.
Lancet. 1987; 2:1351-4. [IDIS 236469] [PubMed 2890951]

566. Grotta JC. Current medical and surgical therapy for cerebrovascular disease. N Engl J Med. 1987;
317:1505-16. [IDIS 236147] [PubMed 3317048]

567. Fields WS. Dipyridamole. N Engl J Med. 1987; 317:1735.

568. Goldberg TH. Dipyridamole. N Engl J Med. 1987; 317:1735.

569. Genton E, Clagett GP, Salzman EW. American College of Chest Physicians and the National
Heart, Lung, and Blood Institute National Conference on Antithrombotic Therapy. Antithrombotic
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3940794]

570. Sherman DG, Dyken ML, Fisher M et al. American College of Chest Physicians and the National
Heart, Lung, and Blood Institute National Conference on Antithrombotic Therapy. Cerebral
embolism. Chest. 1986; 89(Suppl):82-98S.

571. Anon. Doubts about dipyridamole as an antithrombotic drug. Drug Ther Bull. 1984; 22:25-8.
[PubMed 6368165]

572. Rivey MP, Alexander MR, Taylor JW. Dipyridamole: a critical evaluation. Drug Intell Clin
Pharm. 1984; 18:869-80. [IDIS 192040] [PubMed 6389068]

573. The Steering Committee of the Physicians' Health Study Research Group. Preliminary report:
findings from the aspirin component of the ongoing physicians' health study. N Engl J Med. 1988;
318:262-4. [IDIS 237404] [PubMed 3275899]

574. Relman AS. Aspirin for the primary prevention of myocardial infarction. N Engl J Med. 1988;
318:245-6. [IDIS 237400] [PubMed 3275897]

575. Peto R, Gray R, Collins R et al. Randomised trial of prophylactic daily aspirin in British male
doctors. BMJ. 1988; 296:313-6. [IDIS 238642] [PubMed 3125882] [Free Fulltext PMC]

576. Orme M. Aspirin all round. BMJ. 1988; 296:307-8. [IDIS 238640] [PubMed 3125876] [Free
Fulltext PMC]

577. UK-TIA Study Group. United Kingdom transient ischaemic attack (UK-TIA) aspirin trial: interim
results. BMJ. 1988; 296:316-20. [PubMed 2894232] [Free Fulltext PMC]

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578. Anon. Labeling for oral and rectal over-the-counter aspirin and aspirin-containing drug products:
Reye syndrome warning. Fed Regist. 1988; 53:21633-7.

579. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Randomised trial of
IV streptokinase, oral aspirin, both, or neither among 17 187 cases of suspected acute myocardial
infarction: ISIS-2. Lancet. 1988; 2:349-60. [PubMed 2899772]

580. Genentech, Inc. Activase® (alteplase, recombinant: a tissue plasminogen activator) prescribing
information. South San Francisco, CA; 1988 Jun.

581. Topol EJ, Califf RM, George BS et al. A randomized trial of immediate versus delayed elective
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