Aspirin

CLINICAL USE


NSAID:

  • Analgesic and antipyretic
  • Prophylaxis of cerebrovascular disease or myocardial infarction

    DOSE IN NORMAL RENAL FUNCTION

  • Analgesia: 300 mg – 1 g every 4 hours. Maximum 8 g daily in acute conditions
  • Prophylaxis of cerebrovascular disease or myocardial infarction: 75–300 mg daily

    PHARMACOKINETICS

  • Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :180.2
  • %Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :80–90
  • %Excreted unchanged in urine &nbsp &nbsp : 2 (acidic urine); 30 (alkaline urine)

  • Volume of distribution (L/kg) &nbsp &nbsp &nbsp :0.1–0.2

  • half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp :2–3/Unchanged

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

  • 20 to 50 &nbsp &nbsp : Dose as in normal renal function. See ‘Other Information’
  • 10 to 20 &nbsp &nbsp : Dose as in normal renal function. See ‘Other Information’
  • <10 &nbsp &nbsp &nbsp &nbsp &nbsp : Dose as in normal renal function. See ‘Other Information’

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:Dialysed. Dose as in normal renal function

  • HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Dialysed. Dose as in normal renal function
  • HDF/high flux &nbsp :Dialysed. Dose as in normal renal function
  • CAV/VVHD &nbsp &nbsp &nbsp:Dialysed. Dose as in normal renal function

    IMPORTANT DRUG INTERACTIONS

  • Potentially hazardous interactions with other drugs
  • ACE inhibitors and angiotensin-II antagonists: antagonism of hypotensive effect, increased risk of nephrotoxicity and hyperkalaemia
  • Analgesics: avoid concomitant use of 2 or more NSAIDs, including aspirin – increased side effects; avoid with ketorolac – increased risk of side effects and haemorrhage
  • Antibacterials: possibly increased risk of convulsions with quinolonesAnticoagulants: effects of coumarins enhanced; possibly increased risk of bleeding with heparins and coumarins
  • Antidepressants: increased risk of bleeding with SSRIs and venlaflaxine
  • Antidiabetic agents: effects of sulphonylureas enhanced
  • Anti-epileptics: possibly increased phenytoin concentration
  • Antivirals: increased risk of haematological toxicity with zidovudine; concentration possibly increased by ritonavir
  • Ciclosporin: may potentiate nephrotoxicity
  • Cytotoxic agents: reduced excretion of methotrexate; increased risk of bleeding with erlotinibDiuretics: increased risk of nephrotoxicity; antagonism of diuretic effect, hyperkalaemia with potassium-sparing diuretics
  • Lithium: excretion decreased
  • Pentoxifylline: increased risk of bleeding
  • Tacrolimus: increased risk of nephrotoxicity

    ADMINISTRATION

    Reconstition

    –

    Route

    Oral

    Rate of Administration

    –

    Comments

    –

    OTHER INFORMATION

    Aspirin at analgesic/antipyretic dose is best avoided in patients with renal impairment, especially if severe
  • Antiplatelet effect may add to uraemic gastrointestinal and haematologic symptoms
  • Degree of protein binding reduced in ESRD
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