Aspirin Uses, Dosage, Side Effects & Benefits | DrugsAtlas
Authoritative Clinical Reference
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Therapeutic Class
Antiplatelet agent / Analgesic / Antipyretic
Subclass
Non-steroidal anti-inflammatory drug (NSAID), Salicylate
Speciality
Cardiology
Schedule (India)
Schedule H
Routes
Oral, Rectal, Intravenous (NOT AVAILABLE in India)
Formulations
- 75 mg, 81 mg, 100 mg, 150 mg, 300 mg tablets (enteric-coated or plain)
- 325 mg, 500 mg tablets (analgesic/antipyretic use)
- 75 mg, 150 mg dispersible/chewable tablets (specialist use)
- 350 mg, 500 mg rectal suppository (limited availability)
- NOT AVAILABLE in India: IV formulation
Adult indications
Primary Indications (Approved / Standard in India)
1. Secondary Prevention of Cardiovascular and Cerebrovascular Events
(Post-MI, Post-stroke, TIA, Peripheral Arterial Disease)
| Parameter | Dose |
|---|---|
|
Starting dose
|
75–150 mg once daily |
|
Titration
|
Not applicable |
|
Usual maintenance dose
|
75–150 mg once daily |
|
Maximum dose
|
150 mg once daily |
Clinical Notes:
- Enteric-coated formulation preferred for long-term use
- Combine with clopidogrel for first 12 months post-ACS or post-PCI
- Indefinite therapy unless contraindicated
2. Acute Coronary Syndrome (STEMI / NSTEMI / Unstable Angina)
| Phase | Dose | Notes |
|---|---|---|
|
Loading dose
|
150–325 mg stat | Chew non-enteric coated tablet for rapid absorption |
|
Titration
|
Not applicable | — |
|
Maintenance dose
|
75–150 mg once daily | Start from Day 1 |
|
Maximum dose
|
325 mg (loading); 150 mg (maintenance) | — |
Clinical Notes:
- Co-administer with P2Y12 inhibitor (clopidogrel/ticagrelor/prasugrel) as per DAPT protocol
- Continue anticoagulation per institutional ACS pathway
- Do NOT use enteric-coated tablets for loading (delayed absorption)
3. Analgesic / Antipyretic (Short-term Use Only)
| Parameter | Dose |
|---|---|
|
Starting dose
|
325–500 mg every 4–6 hours as needed |
|
Titration
|
Not applicable |
|
Usual maintenance dose
|
325–500 mg every 4–6 hours |
|
Maximum dose
|
4 g/day |
Clinical Notes:
- Use limited to short-term only due to GI and bleeding risks
- Paracetamol preferred in most analgesic/antipyretic settings
- Avoid in patients with peptic ulcer history or concurrent anticoagulation
Secondary Indications – Adults (Off-label)
| Indication | Dose | Duration | Supervision | Evidence Basis |
|---|---|---|---|---|
|
Prevention of Pre-eclampsia (OFF-LABEL)
|
75–150 mg once daily at bedtime | 12–16 weeks gestation until 36 weeks | Specialist only (Obstetrician) | FOGSI consensus; ICMR high-risk pregnancy guidance |
|
Colorectal Cancer Chemoprevention (OFF-LABEL)
|
75–100 mg once daily | Long-term (years) | Specialist only (Oncologist/Gastroenterologist) | International RCTs (CAPP2, ASPREE); not standard Indian public health practice |
Paediatric indications
PAEDIATRIC DOSING (Specialist Only)
Not recommended in children <16 years except for specific indications below due to risk of Reye's syndrome.
Primary Indication: Kawasaki Disease
Minimum Age: ≥6 months
| Phase | Dose | Duration | Monitoring |
|---|---|---|---|
|
Acute phase (High-dose)
|
30–50 mg/kg/day in 4 divided doses | Until 2–3 days after fever resolution | Platelet count, LFTs, bleeding signs |
|
Titration
|
Step down to low-dose once afebrile | — | — |
|
Maintenance (Low-dose)
|
3–5 mg/kg once daily | 6–8 weeks minimum; longer if coronary abnormalities persist | Echocardiography, platelet count |
|
Maximum dose
|
4 g/day (acute phase) | — | — |
Clinical Notes:
- Always use with IVIG in acute Kawasaki disease
- Continue low-dose aspirin until coronary arteries normalise on imaging
- Follow IAP Kawasaki Management Guidelines
Secondary Indications – Paediatrics (Off-label)
| Indication | Dose | Duration | Supervision | Evidence Basis |
|---|---|---|---|---|
|
Antiplatelet therapy post cardiac surgery / congenital heart disease (OFF-LABEL)
|
1–5 mg/kg once daily | As directed by cardiologist | Specialist only (Paediatric Cardiologist) | Indian paediatric cardiology practice; limited RCT data |
Renal Adjustments
| eGFR (mL/min/1.73 m²) | Recommendation |
|---|---|
| >60 | No adjustment required |
| 30–60 | Use with caution; monitor renal function regularly |
| <30 |
Avoid — increased bleeding and nephrotoxicity risk
|
| Haemodialysis | Avoid chronic use; not effectively dialysed |
Hepatic adjustment
Contraindications
- Hypersensitivity to aspirin, salicylates, or any excipients
- Active peptic ulcer disease or gastrointestinal bleeding
- Haemorrhagic disorders (haemophilia, severe thrombocytopenia)
- Severe hepatic impairment
- Severe renal impairment (eGFR <30)
- Third trimester of pregnancy
- Children/adolescents with viral illness (varicella, influenza) — Reye's syndrome risk
- History of aspirin-induced asthma, urticaria, or angioedema
Cautions
- Asthma or history of bronchospasm (aspirin-exacerbated respiratory disease)
- Concurrent anticoagulant or antiplatelet therapy
- History of peptic ulcer disease (healed)
- G6PD deficiency (risk of haemolysis at high doses)
- Chronic kidney disease (dose-dependent worsening)
- Uncontrolled hypertension
- Perioperative period — discontinue 5–7 days prior to surgery if bleeding risk unacceptable
- Gout (low-dose aspirin may increase uric acid levels)
Pregnancy
| Trimester | Safety | Notes |
|---|---|---|
|
1st
|
Use only if essential; avoid high doses | Theoretical risk of fetal loss; limited data |
|
2nd
|
May be used with caution at low doses | Consider for high-risk pre-eclampsia prophylaxis under specialist guidance |
|
3rd
|
Avoid
|
Risk of premature ductus arteriosus closure, oligohydramnios, maternal/fetal bleeding; stop by 36 weeks |
Preferred Alternative for Analgesia: Paracetamol
Monitoring: Bleeding parameters, amniotic fluid volume (if continued beyond 28 weeks)
Lactation
| Parameter | Information |
|---|---|
|
Compatibility
|
Compatible at low doses (≤150 mg/day) |
|
Preferred Alternative
|
Paracetamol (for analgesia) |
|
Expected Drug Level in Milk
|
Low |
|
Infant Monitoring
|
Bruising, feeding difficulties, GI symptoms (rare) |
Elderly
| Parameter | Recommendation |
|---|---|
|
Starting dose
|
Same as adult; use lower end of range |
|
Titration
|
Slower titration for analgesic use |
|
Increased Risks
|
GI bleeding, renal impairment, tinnitus, falls (via drug interactions) |
|
Additional Measures
|
Co-prescribe PPI for long-term CV prevention use |
Major drug interactions
| Interacting Drug | Effect | Management |
|---|---|---|
|
Warfarin
|
↑↑ Bleeding risk | Avoid unless compelling indication; close INR and bleeding monitoring |
|
DOACs (apixaban, rivaroxaban, dabigatran)
|
↑↑ Bleeding risk | Avoid unless cardiologist-directed; monitor for bleeding |
|
Ibuprofen and other NSAIDs
|
May antagonise antiplatelet effect of aspirin | Avoid; if essential, give aspirin 30 min before ibuprofen |
|
Methotrexate (high-dose)
|
↓ MTX clearance → ↑ toxicity | Avoid concurrent use with high-dose MTX; monitor closely with low-dose MTX |
|
SSRIs (sertraline, fluoxetine)
|
↑ GI bleeding risk | Consider PPI cover; monitor for bleeding |
|
Probenecid / Sulfinpyrazone
|
Aspirin antagonises uricosuric effect | Avoid combination in gout management |
Moderate drug interactions
| Interacting Drug | Effect | Management |
|---|---|---|
|
ACE inhibitors / ARBs
|
Reduced antihypertensive effect | Monitor blood pressure |
|
Diuretics (loop, thiazide)
|
Reduced diuretic efficacy; ↑ nephrotoxicity | Monitor renal function and fluid status |
|
Sulfonylureas
|
Hypoglycaemia (protein binding displacement) | Monitor blood glucose; rare clinical significance |
|
Corticosteroids
|
Additive gastric toxicity | Use PPI cover if concurrent use required |
|
Valproic acid
|
↑ Valproate levels (protein binding displacement) | Monitor valproate levels |
|
Alcohol
|
↑ GI bleeding risk | Counsel patient to limit alcohol |
Common Adverse effects
- Dyspepsia, epigastric discomfort
- Nausea, heartburn
- Easy bruising
- Minor bleeding (gingival, epistaxis)
- Tinnitus (dose-related; may indicate toxicity
Serious Adverse effects
| Adverse Effect | Clinical Action |
|---|---|
|
GI haemorrhage / peptic ulceration
|
Discontinue; may require hospitalisation, endoscopy, blood transfusion |
|
Intracranial haemorrhage
|
Discontinue immediately; neurosurgical evaluation |
|
Reye's syndrome (children)
|
Contraindicated in viral illness; supportive care if occurs |
|
Anaphylaxis / Aspirin-induced asthma
|
Discontinue permanently; emergency management |
|
Stevens-Johnson Syndrome / TEN
|
Rare; discontinue permanently |
|
Severe bronchospasm
|
Discontinue; bronchodilator therapy |
Monitoring requirements
| Timing | Parameters |
|---|---|
|
Baseline
|
CBC, renal function (creatinine, eGFR), liver enzymes, bleeding history assessment |
|
During therapy (long-term)
|
CBC periodically, faecal occult blood (if GI symptoms), serum creatinine |
|
Acute CV use
|
Bleeding assessment, blood pressure, symptom control |
|
Paediatric (Kawasaki)
|
Platelet count, LFTs, echocardiography, fever curve |
|
Signs of toxicity
|
Tinnitus, hearing changes, hyperventilation (salicylism) |
Brands in India
- Ecosprin™ (USV) — 75 mg, 150 mg, 325 mg
- Loprin™ (Shreya Life Sciences) — 75 mg, 150 mg
- Cardispan™ — enteric-coated low-dose
- Aspisol™ — analgesic dose tablets
- Disprin™ (Reckitt) — dispersible 350 mg
- Colsprin™ — 100 mg
- Fixed-Dose Combinations: Ecosprin-AV (with atorvastatin), Ecosprin Gold (with clopidogrel + atorvastatin), Clopitab-A (with clopidogrel)
Price range (INR)
| Formulation | Price Range | Notes |
|---|---|---|
| 75 mg tablet | ₹0.30–₹1.00 per tablet | Generic/branded |
| 150 mg tablet | ₹0.50–₹1.50 per tablet | — |
| 325 mg tablet | ₹0.80–₹2.00 per tablet | — |
| 500 mg tablet | ₹1.00–₹2.50 per tablet | — |
Regulatory: Listed under NLEM 2022; select strengths under NPPA price control
Clinical pearls
- Acute ACS: Always use non-enteric coated, chewable aspirin for loading — enteric coating delays absorption by 3–4 hours
- Long-term CV prevention: Use enteric-coated formulations to reduce gastric irritation
- NSAID interaction: Ibuprofen given before aspirin blocks the antiplatelet binding site — give aspirin at least 30 minutes before ibuprofen if both required
- Elderly patients: Co-prescribe PPI (pantoprazole/omeprazole) routinely for GI protection in long-term therapy
- Paediatrics: Never prescribe to children <16 years with fever/viral illness — always rule out viral aetiology before considering aspirin
- Bleeding counselling: Educate patients to report black stools, blood in vomit, unusual bruising, or prolonged bleeding from cuts
Version
RxIndia v1.1 — 01 May 2025
⚖️
Clinical Responsibility
This platform is designed strictly for healthcare professionals. Data provided is synthesized from authoritative pharmacological sources and clinical registries. Do not use for consumer medical decisions. Always verify critical dosing and contraindications with official institutional protocols and peer-reviewed journals.
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