Drug reference

Aspirin

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 152, 153

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

Cardiovascular disease (secondary prevention) ▶BY MOUTH ▶Adult: 75 mg daily Management of unstable angina and non-ST-segment elevation myocardial infarction (NSTEMI)| Management of ST-segment elevation myocardial infarction (STEMI) ▶BY MOUTH ▶Adult: 300 mg, chewed or dispersed in water Suspected transient ischaemic attack ▶BY MOUTH ▶Adult: 300 mg once daily until diagnosis established Transient ischaemic attack (long-term treatment in combination with dipyridamole) | Ischaemic stroke not associated with atrial fibrillation (in combination with dipyridamole if clopidogrel contra-indicated or not tolerated) | Ischaemic stroke not associated with atrial fibrillation (used alone if clopidogrel and dipyridamole contra-indicated or not tolerated) ▶BY MOUTH ▶Adult: 75 mg once daily Acute ischaemic stroke ▶BY MOUTH ▶Adult: 300 mg once daily for 14 days, to be initiated 24 hours after thrombolysis or as soon as possible within 48 hours of symptom onset in patients not receiving thrombolysis Atrial fibrillation following a disabling ischaemic stroke (before being considered for anticoagulant treatment) ▶BY MOUTH ▶Adult: 300 mg once daily for 14 days Following disabling ischaemic stroke in patients receiving anticoagulation for a prosthetic heart valve and who are at significant risk of haemorrhagic transformation ▶BY MOUTH ▶Adult: 300 mg once daily, anticoagulant treatment stopped for 7 days and to be substituted with aspirin Following coronary by-pass surgery ▶BY MOUTH ▶Adult: 75–300 mg daily Mild to moderate pain | Pyrexia ▶BY MOUTH ▶Adult: 300–900 mg every 4–6 hours as required; maximum 4 g per day ▶BY RECTUM ▶Adult: 450–900 mg every 4 hours; maximum 3.6 g per day Acute migraine ▶BY MOUTH ▶Adult: 900 mg for 1 dose, to be taken as soon as migraine symptoms develop Prevention of pre-eclampsia in women at moderate or high risk ▶BY MOUTH ▶Adult: 75–150 mg once daily from 12 weeks gestation until the birth of the baby Mild to moderate pain (dose approved for use by community practitioner nurse prescribers) | Pyrexia (dose approved for use by community practitioner nurse prescribers) ▶BY MOUTH ▶Child 16–17 years: 300–600 mg every 4–6 hours as required, maximum 2.4 g per day without doctor’s advice ▶Adult: 300–600 mg every 4–6 hours as required, maximum 2.4 g per day without doctor’s advice l UNLICENSED USE ▶With oral use in adults g Aspirin is used to prevent pre- eclampsia in women at moderate or high risk, h but is not licensed for this indication.

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Contra Indications

Active peptic ulceration. bleeding disorders. children under 16 years (risk of Reye’s syndrome). haemophilia. previous peptic ulceration (analgesic dose). severe cardiac failure (analgesic dose) CONTRA-INDICATIONS, FURTHER INFORMATION ▶Reye’s syndrome Owing to an association with Reye’s syndrome, manufacturer advises aspirin-containing preparations should not be given to children under 16 years, unless speciﬁcally indicated, e.g. for Kawasaki disease.

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Cautions

Allergic disease. anaemia. asthma. dehydration. elderly. G6PD deﬁciency. preferably avoid during fever or viral infection in children (risk of Reye’s syndrome). previous peptic ulceration (but manufacturers may advise avoidance of low-dose aspirin in history of peptic ulceration). thyrotoxicosis. uncontrolled hypertension CAUTIONS, FURTHER INFORMATION ▶Elderly Prescription potentially inappropriate (STOPP criteria): . at long-term doses greater than 160 mg daily (increased risk of bleeding, no evidence for increased efﬁcacy) . with a past history of peptic ulcer disease without concomitant proton pump inhibitor use (risk of recurrent peptic ulcer) . with concurrent signiﬁcant bleeding risk, such as uncontrolled severe hypertension, bleeding diathesis or recent non-trivial spontaneous bleeding (high risk of bleeding) . when used with clopidogrel as secondary stroke prevention unless the patient has a coronary stent(s) inserted in the previous 12 months, or concurrent acute coronary syndrome, or has a high grade symptomatic carotid arterial stenosis (no evidence of added beneﬁt over clopidogrel monotherapy) . when used with vitamin K antagonists, direct thrombin inhibitors or factor Xa inhibitors in patients with chronic atrial ﬁbrillation (no added beneﬁt from aspirin) See also Prescribing in the elderly p. 33.

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Allergy And Cross Sensitivity

Aspirin is contra- indicated in history of hypersensitivity to aspirin or any other NSAID—which includes those in whom attacks of asthma, angioedema, urticaria, or rhinitis have been precipitated by aspirin or any other NSAID.

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Prescribing And Dispensing Information

▶In adults BP directs that when no strength is stated the 300 mg strength should be dispensed, and that when soluble aspirin tablets are prescribed, dispersible aspirin tablets shall be dispensed. l PROFESSION SPECIFIC INFORMATION Dental practitioners’ formulary Aspirin Dispersible Tablets 300 mg may be prescribed.

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Exceptions To Legal Category

Can be sold to the public provided packs contain no more than 32 capsules or tablets; pharmacists can sell multiple packs up to a total quantity of 100 capsules or tablets in justiﬁable circumstances.

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Safety

Interactions

→Appendix 1: aspirin

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Side Effects

GENERAL SIDE-EFFECTS ▶Rare or very rare Asthmatic attack. bronchospasm SPECIFIC SIDE-EFFECTS ▶Common or very common ▶With oral use Dyspepsia. haemorrhage ▶Uncommon ▶With oral use Dyspnoea. rhinitis. severe cutaneous adverse reactions (SCARs). skin reactions ▶Rare or very rare ▶With oral use Aplastic anaemia. erythema nodosum. gastrointestinal haemorrhage (severe). granulocytosis. haemorrhagic vasculitis. intracranial haemorrhage. menorrhagia. nausea. thrombocytopenia. vomiting ▶Frequency not known ▶With oral use Fluid retention. gastrointestinal disorders. headache. hearing loss. hepatic failure. hyperuricaemia. iron deﬁciency anaemia. renal impairment. sodium retention. tinnitus. vertigo Overdose The main features of salicylate poisoning are hyperventilation, tinnitus, deafness, vasodilatation, and sweating. Coma is uncommon but indicates very severe poisoning. For speciﬁc details on the management of poisoning, see Aspirin, under Emergency treatment of poisoning p. 1430.

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Pregnancy

Use antiplatelet doses with caution during third trimester; impaired platelet function and risk of haemorrhage; delayed onset and increased duration of labour with increased blood loss; avoid analgesic doses if possible in last few weeks (low doses probably not harmful); high doses may be related to intra-uterine growth restriction, teratogenic effects, closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of newborn; kernicterus may occur in jaundiced neonates.

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Breast Feeding

Avoid—possible risk of Reye’s syndrome; regular use of high doses could impair platelet function and produce hypoprothrombinaemia in infant if neonatal vitamin K stores low.

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Hepatic Impairment

Manufacturer advises use with caution in mild-to-moderate impairment; avoid in severe impairment.

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Renal Impairment

Use with caution; avoid in severe impairment; sodium and water retention; deterioration in renal function; increased risk of gastro-intestinal bleeding.

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Dose and formulations

Medicinal Forms

There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: capsule, oral suspension, oral solution Cardiovascular system Gastro-resistant tablet CAUTIONARY AND ADVISORY LABELS 5, 25, 32 ▶Aspirin (Non-proprietary) Aspirin 75 mg Aspirin 75mg gastro-resistant tablets | 28 tablet p £0.86 DT = £0.86 | 28 tablet G £1.48 DT = £0.86 | 56 tablet p £1.66–£1.72 | 56 tablet G £2.22 Aspirin 300 mg Aspirin 300mg gastro-resistant tablets | 100 tablet P £25.29 DT = £25.29 ▶Nu-Seals (Alliance Pharmaceuticals Ltd) Aspirin 75 mg Nu-Seals 75 gastro-resistant tablets | 56 tablet p £3.12 Tablet CAUTIONARY AND ADVISORY LABELS 21, 32 ▶Aspirin (Non-proprietary) Aspirin 75 mg Aspirin 75mg tablets | 28 tablet P £3.50 DT = £1.38 Aspirin 300 mg Aspirin 300mg tablets | 32 tablet p £3.42 DT = £3.42 | 32 tablet G s DT = £3.42 | 100 tablet P £1.12–£10.68 Suppository CAUTIONARY AND ADVISORY LABELS 32 ▶Aspirin (Non-proprietary) Aspirin 150 mg Aspirin 150mg suppositories | 10 suppository p £20.54 DT = £20.54 Aspirin 300 mg Aspirin 300mg suppositories | 10 suppository p £39.48 DT = £39.48 Dispersible tablet CAUTIONARY AND ADVISORY LABELS 13, 21, 32 ▶Aspirin (Non-proprietary) Aspirin 75 mg Aspirin 75mg dispersible tablets | 28 tablet p £0.62 DT = £0.81 | 100 tablet p £0.64–£2.75 DT = £2.89 | 1000 tablet P £27.50–£28.90 Aspirin 300 mg Aspirin 300mg dispersible tablets | 32 tablet p £1.08 DT = £1.08 | 100 tablet P £0.94 DT = £3.38 ▶Danamep (Ecogen Europe Ltd) Aspirin 75 mg Danamep 75mg dispersible tablets | 28 tablet P £0.50 DT = £0.81 ▶Disprin (Reckitt Benckiser Healthcare (UK) Ltd) Aspirin 300 mg Disprin 300mg dispersible tablets | 32 tablet p £1.94 DT = £1.08

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Dose text by age group

Child 16–17 years

300–600 mg every 4–6 hours as

First-line fragment. Read the complete Indications and Dose section above.

PDF page 152

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.

Drug reference

Aspirin

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 152, 153

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

PDF page 152

Contra Indications

PDF page 152

Cautions

PDF page 152

Allergy And Cross Sensitivity

PDF page 153

Prescribing And Dispensing Information

PDF page 153

Exceptions To Legal Category

PDF page 153

Safety

Interactions

→Appendix 1: aspirin

PDF page 152

Side Effects

PDF page 153

Pregnancy

PDF page 153

Breast Feeding

Avoid—possible risk of Reye’s syndrome; regular use of high doses could impair platelet function and produce hypoprothrombinaemia in infant if neonatal vitamin K stores low.

PDF page 153

Hepatic Impairment

Manufacturer advises use with caution in mild-to-moderate impairment; avoid in severe impairment.

PDF page 153

Renal Impairment

Use with caution; avoid in severe impairment; sodium and water retention; deterioration in renal function; increased risk of gastro-intestinal bleeding.

PDF page 153

Dose and formulations

Medicinal Forms

PDF page 153

Dose text by age group

Child 16–17 years

300–600 mg every 4–6 hours as

First-line fragment. Read the complete Indications and Dose section above.

PDF page 152

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.