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Aspirin


Pronunciation

 (AS pir in)


U.S. Brand Names

 Ascriptin® [OTC]; Ascriptin® Extra Strength [OTC]; Aspercin [OTC]; Aspercin Extra [OTC]; Aspergum® [OTC]; Bayer® Aspirin [OTC]; Bayer® Aspirin Extra Strength [OTC]; Bayer® Aspirin Regimen Adult Low Strength [OTC]; Bayer® Aspirin Regimen Children's [OTC]; Bayer® Aspirin Regimen Regular Strength [OTC]; Bayer® Extra Strength Arthritis Pain Regimen [OTC]; Bayer® Plus Extra Strength [OTC]; Bayer® Women's Aspirin Plus Calcium [OTC]; Bufferin® [OTC]; Bufferin® Extra Strength [OTC]; Buffinol [OTC]; Buffinol Extra [OTC]; Easprin®; Ecotrin® [OTC]; Ecotrin® Low Strength [OTC]; Ecotrin® Maximum Strength [OTC]; Halfprin® [OTC]; St. Joseph® Adult Aspirin [OTC]; Sureprin 81™ [OTC]; ZORprin®


Synonyms

 Acetylsalicylic Acid; ASA


Generic Available

 Yes: Excludes gum


Canadian Brand Names

 Asaphen; Asaphen E.C.; Entrophen®; Novasen


Use

 Treatment of mild-to-moderate pain, inflammation, and fever; may be used as prophylaxis of myocardial infarction; prophylaxis of stroke and/or transient ischemic episodes; management of rheumatoid arthritis, rheumatic fever, osteoarthritis, and gout (high dose); adjunctive therapy in revascularization procedures (coronary artery bypass graft [CABG], percutaneous transluminal coronary angioplasty [PTCA], carotid endarterectomy), stent implantation


Use - Dental

 Treatment of postoperative pain


Use - Unlabeled/Investigational

 Low doses have been used in the prevention of pre-eclampsia, complications associated with autoimmune disorders such as lupus or antiphospholipid syndrome


Pregnancy Risk Factor

 C/D (full-dose aspirin in 3rd trimester - expert analysis)


Pregnancy Implications

 Salicylates have been noted to cross the placenta and enter fetal circulation. Adverse effects reported in the fetus include mortality, intrauterine growth retardation, salicylate intoxication, bleeding abnormalities, and neonatal acidosis. Use of aspirin close to delivery may cause premature closure of the ductus arteriosus. Adverse effects reported in the mother include anemia, hemorrhage, prolonged gestation, and prolonged labor. Aspirin has been used for the prevention of pre-eclampsia; however, the ACOG currently recommends that it not be used in low-risk women. Low-dose aspirin is used to treat complications resulting from antiphospholipid syndrome in pregnancy (either primary or secondary to SLE). In general, low doses during pregnancy needed for the treatment of certain medical conditions have not been shown to cause fetal harm, however, discontinuing therapy prior to delivery is recommended. Use of safer agents for routine management of pain or headache should be considered.


Lactation

 Enters breast milk/use caution


Contraindications

 Hypersensitivity to salicylates, other NSAIDs, or any component of the formulation; asthma; rhinitis; nasal polyps; inherited or acquired bleeding disorders (including factor VII and factor IX deficiency); do not use in children (<16 years of age) for viral infections (chickenpox or flu symptoms), with or without fever, due to a potential association with Reye's syndrome; pregnancy (3rd trimester especially)


Warnings/Precautions

 Use with caution in patients with platelet and bleeding disorders, renal dysfunction, dehydration, erosive gastritis, or peptic ulcer disease. Heavy ethanol use (>3 drinks/day) can increase bleeding risks. Avoid use in severe renal failure or in severe hepatic failure. Discontinue use if tinnitus or impaired hearing occurs. Caution in mild-moderate renal failure (only at high dosages). Patients with sensitivity to tartrazine dyes, nasal polyps and asthma may have an increased risk of salicylate sensitivity. Surgical patients should avoid ASA if possible, for 1-2 weeks prior to surgery, to reduce the risk of excessive bleeding.

When used for self-medication (OTC labeling): Children and teenagers who have or are recovering from chickenpox or flu-like symptoms should not use this product. Changes in behavior (along with nausea and vomiting) may be an early sign of Reye's syndrome; patients should be instructed to contact their healthcare provider if these occur.


Adverse Reactions

 As with all drugs which may affect hemostasis, bleeding is associated with aspirin. Hemorrhage may occur at virtually any site. Risk is dependent on multiple variables including dosage, concurrent use of multiple agents which alter hemostasis, and patient susceptibility. Many adverse effects of aspirin are dose related, and are rare at low dosages. Other serious reactions are idiosyncratic, related to allergy or individual sensitivity. Accurate estimation of frequencies is not possible. The reactions listed below have been reported for aspirin.

Cardiovascular: Hypotension, tachycardia, dysrhythmias, edema

Central nervous system: Fatigue, insomnia, nervousness, agitation, confusion, dizziness, headache, lethargy, cerebral edema, hyperthermia, coma

Dermatologic: Rash, angioedema, urticaria

Endocrine & metabolic: Acidosis, hyperkalemia, dehydration, hypoglycemia (children), hyperglycemia, hypernatremia (buffered forms)

Gastrointestinal: Nausea, vomiting, dyspepsia, epigastric discomfort, heartburn, stomach pain, gastrointestinal ulceration (6% to 31%), gastric erosions, gastric erythema, duodenal ulcers

Hematologic: Anemia, disseminated intravascular coagulation, prolongation of prothrombin times, coagulopathy, thrombocytopenia, hemolytic anemia, bleeding, iron-deficiency anemia

Hepatic: Hepatotoxicity, transaminases increased, hepatitis (reversible)

Neuromuscular & skeletal: Rhabdomyolysis, weakness, acetabular bone destruction (OA)

Otic: Hearing loss, tinnitus

Renal: Interstitial nephritis, papillary necrosis, proteinuria, renal impairment, renal failure (including cases caused by rhabdomyolysis), increased BUN, increased serum creatinine

Respiratory: Asthma, bronchospasm, dyspnea, laryngeal edema, hyperpnea, tachypnea, respiratory alkalosis, noncardiogenic pulmonary edema

Miscellaneous: Anaphylaxis, prolonged pregnancy and labor, stillbirths, low birth weight, peripartum bleeding, Reye's syndrome

Postmarketing and/or case reports: Colonic ulceration, esophageal stricture, esophagitis with esophageal ulcer, esophageal hematoma, oral mucosal ulcers (aspirin-containing chewing gum), coronary artery spasm, conduction defect and atrial fibrillation (toxicity), delirium, ischemic brain infarction, colitis, rectal stenosis (suppository), cholestatic jaundice, periorbital edema, rhinosinusitis


Overdosage/Toxicology

 Symptoms of overdose include tinnitus, headache, dizziness, confusion, metabolic acidosis, hyperpyrexia, hypoglycemia, and coma. Treatment should be based upon symptomatology.


Drug Interactions

 Substrate of CYP2C8/9 (minor)

ACE inhibitors: The effects of ACE inhibitors may be blunted by aspirin administration, particularly at higher dosages.

Buspirone increases aspirin's free % in vitro .

Carbonic anhydrase inhibitors and corticosteroids have been associated with alteration in salicylate serum concentrations.

Heparin and low molecular weight heparins: Concurrent use may increase the risk of bleeding.

Methotrexate serum levels may be increased; consider discontinuing aspirin 2-3 days before high-dose methotrexate treatment or avoid concurrent use.

NSAIDs may increase the risk of gastrointestinal adverse effects and bleeding. Serum concentrations of some NSAIDs may be decreased by aspirin.

Platelet inhibitors (IIb/IIIa antagonists): Risk of bleeding may be increased.

Probenecid effects may be antagonized by aspirin.

Sulfonylureas: The effects of older sulfonylurea agents (tolazamide, tolbutamide) may be potentiated due to displacement from plasma proteins. This effect does not appear to be clinically significant for newer sulfonylurea agents (glyburide, glipizide, glimepiride).

Valproic acid may be displaced from its binding sites which can result in toxicity.

Verapamil may potentiate the prolongation of bleeding time associated with aspirin.

Warfarin and oral anticoagulants may increase the risk of bleeding.


Ethanol/Nutrition/Herb Interactions

Ethanol: Avoid ethanol (may enhance gastric mucosal damage).

Food: Food may decrease the rate but not the extent of oral absorption.

Folic acid: Hyperexcretion of folate; folic acid deficiency may result, leading to macrocytic anemia.

Iron: With chronic aspirin use and at doses of 3-4 g/day, iron-deficiency anemia may result.

Sodium: Hypernatremia resulting from buffered aspirin solutions or sodium salicylate containing high sodium content. Avoid or use with caution in CHF or any condition where hypernatremia would be detrimental.

Benedictine liqueur, prunes, raisins, tea, and gherkins: Potential salicylate accumulation.

Fresh fruits containing vitamin C: Displace drug from binding sites, resulting in increased urinary excretion of aspirin.

Herb/Nutraceutical: Avoid cat's claw, dong quai, evening primrose, feverfew, garlic, ginger, ginkgo, red clover, horse chestnut, green tea, ginseng (all have additional antiplatelet activity). Limit curry powder, paprika, licorice; may cause salicylate accumulation. These foods contain 6 mg salicylate/100 g. An ordinarily American diet contains 10-200 mg/day of salicylate.


Stability

 Keep suppositories in refrigerator, do not freeze; hydrolysis of aspirin occurs upon exposure to water or moist air, resulting in salicylate and acetate, which possess a vinegar-like odor; do not use if a strong odor is present


Mechanism of Action

 Inhibits prostaglandin synthesis, acts on the hypothalamus heat-regulating center to reduce fever, blocks prostaglandin synthetase action which prevents formation of the platelet-aggregating substance thromboxane A2


Pharmacodynamics/Kinetics

Duration: 4-6 hours

Absorption: Rapid

Distribution: Vd: 10 L; readily into most body fluids and tissues

Metabolism: Hydrolyzed to salicylate (active) by esterases in GI mucosa, red blood cells, synovial fluid, and blood; metabolism of salicylate occurs primarily by hepatic conjugation; metabolic pathways are saturable

Bioavailability: 50% to 75% reaches systemic circulation

Half-life elimination: Parent drug: 15-20 minutes; Salicylates (dose dependent): 3 hours at lower doses (300-600 mg), 5-6 hours (after 1 g), 10 hours with higher doses

Time to peak, serum: ~1-2 hours

Excretion: Urine (75% as salicyluric acid, 10% as salicylic acid)


Dosage

Children:

Analgesic and antipyretic: Oral, rectal: 10-15 mg/kg/dose every 4-6 hours, up to a total of 4 g/day

Anti-inflammatory: Oral: Initial: 60-90 mg/kg/day in divided doses; usual maintenance: 80-100 mg/kg/day divided every 6-8 hours; monitor serum concentrations

Antiplatelet effects: Adequate pediatric studies have not been performed; pediatric dosage is derived from adult studies and clinical experience and is not well established; suggested doses have ranged from 3-5 mg/kg/day to 5-10 mg/kg/day given as a single daily dose. Doses are rounded to a convenient amount (eg, 1 /2 of 80 mg tablet).

Mechanical prosthetic heart valves: 6-20 mg/kg/day given as a single daily dose (used in combination with an oral anticoagulant in children who have systemic embolism despite adequate oral anticoagulation therapy (INR 2.5-3.5) and used in combination with low-dose anticoagulation (INR 2-3) and dipyridamole when full-dose oral anticoagulation is contraindicated)

Blalock-Taussig shunts: 3-5 mg/kg/day given as a single daily dose

Kawasaki disease: Oral: 80-100 mg/kg/day divided every 6 hours; monitor serum concentrations; after fever resolves: 3-5 mg/kg/day once daily; in patients without coronary artery abnormalities, give lower dose for at least 6-8 weeks or until ESR and platelet count are normal; in patients with coronary artery abnormalities, low-dose aspirin should be continued indefinitely

Antirheumatic: Oral: 60-100 mg/kg/day in divided doses every 4 hours

Adults:

Analgesic and antipyretic: Oral, rectal: 325-650 mg every 4-6 hours up to 4 g/day

Anti-inflammatory: Oral: Initial: 2.4-3.6 g/day in divided doses; usual maintenance: 3.6-5.4 g/day; monitor serum concentrations

Myocardial infarction prophylaxis: 75-325 mg/day; use of a lower aspirin dosage has been recommended in patients receiving ACE inhibitors

Acute myocardial infarction: 160-325 mg/day (have patient chew tablet if not taking aspirin before presentation)

CABG: 75-325 mg/day starting 6 hours following procedure; if bleeding prevents administration at 6 hours after CABG, initiate as soon as possible

PTCA: Initial: 80-325 mg/day starting 2 hours before procedure; longer pretreatment durations (up to 24 hours) should be considered if lower dosages (80-100 mg) are used

Stent implantation: Oral: 325 mg 2 hours prior to implantation and 160-325 mg daily thereafter

Carotid endarterectomy: 81-325 mg/day preoperatively and daily thereafter

Acute stroke : 160-325 mg/day, initiated within 48 hours (in patients who are not candidates for thrombolytics and are not receiving systemic anticoagulation)

Stroke prevention/TIA: 30-325 mg/day (dosages up to 1300 mg/day in 2-4 divided doses have been used in clinical trials)

Pre-eclampsia prevention (unlabeled use): 60-80 mg/day during gestational weeks 13-26 (patient selection criteria not established)

Dosing adjustment in renal impairment: Clcr<10 mL/minute: Avoid use.

Hemodialysis: Dialyzable (50% to 100%)

Dosing adjustment in hepatic disease: Avoid use in severe liver disease.


Administration

 Do not crush sustained release or enteric coated tablet. Administer with food or a full glass of water to minimize GI distress. For acute myocardial infarction, have patient chew tablet.


Reference Range

 Timing of serum samples: Peak levels usually occur 2 hours after ingestion. Salicylate serum concentrations correlate with the pharmacological actions and adverse effects observed. The serum salicylate concentration (mcg/mL) and the corresponding clinical correlations are as follows: See table.

Test Interactions

Serum Salicylate: Clinical Correlations

Serum Salicylate Concentration
(mcg/mL)		 Desired Effects Adverse Effects / Intoxication
~100 Antiplatelet
Antipyresis
Analgesia		 GI intolerance and bleeding, hypersensitivity, hemostatic defects
150-300 Anti-inflammatory Mild salicylism
250-400 Treatment of rheumatic fever Nausea/vomiting, hyperventilation, salicylism, flushing, sweating, thirst, headache, diarrhea, and tachycardia
>400-500 &nbsp; Respiratory alkalosis, hemorrhage, excitement, confusion, asterixis, pulmonary edema, convulsions, tetany, metabolic acidosis, fever, coma, cardiovascular collapse, renal and respiratory failure



Test Interactions

 False-negative results for glucose oxidase urinary glucose tests (Clinistix®); false-positives using the cupric sulfate method (Clinitest®); also, interferes with Gerhardt test, VMA determination; 5-HIAA, xylose tolerance test and T3 and T4


Dietary Considerations

 Take with food or large volume of water or milk to minimize GI upset.


Patient Education

 If self-administered, use exactly as directed; do not increase dose or frequency. Adverse reactions can occur with overuse. Take with food or milk. Do not use aspirin with strong vinegar-like odor. Do not crush or chew extended release products. While using this medication, avoid alcohol, excessive amounts of vitamin C, or salicylate-containing foods (eg, curry powder, prunes, raisins, tea, or licorice), other prescription or OTC medications containing aspirin or salicylate, or other NSAIDs without consulting prescriber. Maintain adequate hydration (2-3 L/day of fluids) unless instructed to restrict fluid intake. You may experience nausea, vomiting, gastric discomfort (frequent mouth care, small, frequent meals, sucking lozenges, or chewing gum may help); GI bleeding, ulceration, or perforation (can occur with or without pain); or discoloration of stool (pink/red). Stop taking aspirin and report ringing in ears; persistent stomach pain; unresolved nausea or vomiting; respiratory difficulty or shortness of breath; unusual bruising or bleeding (mouth, urine, stool); or skin rash. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to become pregnant. Consult prescriber if breast-feeding.


Anesthesia and Critical Care Concerns/Other Considerations

Primary Prevention: The U.S. Preventive Services Task Force strongly recommends that clinicians discuss aspirin therapy for primary prevention of heart disease with adults who are at increased risk. The balance of benefits and harm is most favorable in patients at high risk for coronary heart disease (those with a 5-year risk 3%). Risk can be calculated at www.med-decisions.com. Adequate blood pressure control is necessary in hypertensive patients who are candidates for aspirin.

Secondary Prevention: In unstable angina, aspirin reduces the rate of refractory angina, nonfatal MI, and death. Aspirin reduces the rate of recurrent ischemia and infarction, stroke and death following MI. In patients who have acute coronary syndrome (ACS) but are not already receiving aspirin, the first dose may be chewed to rapidly establish a high blood level.


Cardiovascular Considerations

Primary Prevention: The U.S. Preventive Services Task Force strongly recommends that clinicians discuss aspirin therapy for primary prevention of heart disease with adults who are at increased risk. The balance of benefits and harm is most favorable in patients at high risk for coronary heart disease (those with a 5-year risk 3%). Risk can be calculated at www.med-decisions.com. Adequate blood pressure control is necessary in hypertensive patients who are candidates for aspirin.

Secondary Prevention: In unstable angina, aspirin reduces the rate of refractory angina, nonfatal MI, and death. Aspirin reduces the rate of recurrent ischemia and infarction, stroke and death following MI. In patients who have acute coronary syndrome (ACS) but are not already receiving aspirin, the first dose may be chewed to rapidly establish a high blood level.


Dental Health: Effects on Dental Treatment

 Key adverse event(s) related to dental treatment: As with all drugs which may affect hemostasis, bleeding is associated with aspirin. Hemorrhage may occur at virtually any site; risk is dependent on multiple variables including dosage, concurrent use of multiple agents which alter hemostasis, and patient susceptibility. Many adverse effects of aspirin are dose-related, and are rare at low dosages. Other serious reactions are idiosyncratic, related to allergy or individual sensitivity.


Dental Health: Vasoconstrictor/Local Anesthetic Precautions

 No information available to require special precautions


Dental Comment

 There is no scientific evidence to warrant discontinuance of aspirin prior to dental surgery. Patients taking one aspirin tablet daily as an antithrombotic and who require dental surgery should be given special consideration in consultation with the physician before removal of the aspirin relative to prevention of postoperative bleeding.


Mental Health: Effects on Mental Status

 May cause drowsiness


Mental Health: Effects on Psychiatric Treatment

 May cause leukopenia; use caution with clozapine and carbamazepine; may displace valproic acid from binding sites resulting in an increase of unbound drug; monitor for toxicity


Dosage Forms

Caplet:

Bayer® Aspirin: 325 mg [film coated]

Bayer® Aspirin Extra Strength: 500 mg [film coated]

Bayer® Extra Strength Arthritis Pain Regimen: 500 mg [enteric coated]

Bayer® Women's Aspirin Plus Calcium: 81 mg [contains elemental calcium 300 mg]

Caplet, buffered (Ascriptin® Extra Strength): 500 mg [contains aluminum hydroxide, calcium carbonate, and magnesium hydroxide]

Gelcap (Bayer® Aspirin Extra Strength): 500 mg

Gum (Aspergum®): 227 mg [cherry or orange flavor]

Suppository, rectal: 300 mg, 600 mg

Tablet: 325 mg

Aspercin: 325 mg

Aspercin Extra: 500 mg

Bayer® Aspirin: 325 mg [film coated]

Tablet, buffered: 325 mg

Ascriptin®: 325 mg [contains aluminum hydroxide, calcium carbonate, and magnesium hydroxide]

Bayer® Plus Extra Strength: 500 mg [contains calcium carbonate]

Bufferin®: 325 mg [contains citric acid]

Bufferin® Extra Strength: 500 mg [contains citric acid]

Buffinol: 325 mg [contains magnesium oxide]

Buffinol Extra: 500 mg [contains magnesium oxide]

Tablet, chewable: 81 mg

Bayer® Aspirin Regimen Children's Chewable: 81 mg [cherry, mint or orange flavor]

St. Joseph® Adult Aspirin: 81 mg [orange flavor]

Tablet, controlled release (ZORprin®): 800 mg

Tablet, enteric coated: 81 mg, 325 mg, 500 mg, 650 mg

Bayer® Aspirin Regimen Adult Low Strength, Ecotrin® Low Strength, St. Joseph Adult Aspirin: 81 mg

Bayer® Aspirin Regimen Regular Strength, Ecotrin®: 325 mg

Easprin®: 975 mg

Ecotrin® Maximum Strength: 500 mg

Halfprin: 81 mg, 162 mg

Sureprin 81™: 81 mg


References

ACOG Committee on Obstetric Practice, "ACOG Practice Bulletin. Diagnosis and Management of Preeclampsia and Eclampsia. Number 33, January 2002. American College of Obstetricians and Gynecologists," Int J Gynaecol Obstet , 2002, 77(1):67-75.

"American Academy of Pediatrics Committee on Drugs. The Transfer of Drugs and Other Chemicals Into Human Milk," Pediatrics , 2001, 108(3):776-89.

Antman EM, Anbe SC, Alpert JS, et al, "ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction - Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction)," Circulation , 2004, 110:588-636. Available at: http://www.circulationaha.org/cgi/content/full/110/5/588. Last accessed August 26, 2004.

"Aspirin for the Primary Prevention of Cardiovascular Events: Recommendation and Rationale. U.S. Preventive Services Task Force," Ann Intern Med , 2002, 136(2):157-60.

Bar-Oz B, Bulkowstein M, Benyamini L, et al, "Use of Antibiotic and Analgesic Drugs During Lactation," Drug Saf , 2003, 26(13):925-35.

Branch DW and Khamashta MA, "Antiphospholipid Syndrome: Obstetric Diagnosis, Management, and Controversies," Obstet Gynecol , 2003, 101(6):1333-44.

Braunwald E, Antman EM, Beasley JW, et al, "ACC/AHA 2002 Guideline Update for the Management of Patients With Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction - Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina)," J Am Coll Cardiol , 2002, 40(7):1366-74. Available at: http://www.acc.org/clinical/guidelines/unstable/incorporated/index.htm. Accessed May 20, 2003.

Carp HJ, "Antiphospholipid Syndrome in Pregnancy," Curr Opin Obstet Gynecol , 2004, 16(2):129-35.

Chobanian AV, Bakris GL, Black HR, et al, "The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report," JAMA , 2003, 289(19):2560-71.

Coomarasamy A, Honest H, Papaioannou S, et al, "Aspirin for Prevention of Preeclampsia in Women With Historical Risk Factors: A Systematic Review," Obstet Gynecol , 2003, 101(6):1319-32.

Department of Health and Human Services, Food and Drug Administration, "Labeling for Oral and Rectal Over-the-Counter Drug Products Containing Aspirin and Nonaspirin Salicylates; Reye's Syndrome Warning; Final Rule, (29 CFR Part 201)," Federal Register , April 17, 2003, 18861-9.

Mokhlesi B, Leikin JB, Murray P, et al, "Adult Toxicology in Critical Care: Part II: Specific Poisonings," Chest , 2003, 123(3):897-922.

Ostensen M, "Nonsteroidal Anti-inflammatory Drugs During Pregnancy," Scand J Rheumatol Suppl , 1998, 107:128-32.

"Physician's Health Study: Aspirin and Primary Prevention of Coronary Heart Disease," N Engl J Med , 1989, 321(26):1825-8.

Sch&ouml;mig A, Neumann FJ, Kastrati A, et al, "A Randomized Comparison of Antiplatelet and Anticoagulant Therapy After the Placement of Coronary-Artery Stents," N Engl J Med , 1996, 334(17):1084-9.

"Seventh ACCP Consensus Conference on Antithrombotic and Thrombolytic Therapy," Chest , 2004, 126(3 Suppl):172-608.

Spigset O and Hagg S, "Analgesics and Breast-feeding: Safety Considerations," Paediatr Drugs , 2000, 2(3):223-38.

Tincani A, Branch W, Levy RA, et al, "Treatment of Pregnant Patients With Antiphospholipid Syndrome," Lupus , 2003, 12(7):524-9.


International Brand Names

 A.A.S. 500® (PT); AAS® (AR, BR, CZ, ES); Acard® (PL); Acekapton® (AT); Acenterine® (BE, LU); Acesal® (DE, IT, RO); Acesan® (PL); Acesil® (RO); Acesil-T® (RO); Acetisal® (YU); Acetosal® (IL); Acetylin® (DE); Acetylsalicyls&auml;ure-Tabletten Michalik® (DE); Acetylsalicyls&auml;ure von ct® (LU); Acetylsalicylsyre SAD® (DK); Acetysal® (BG, YU); Acetysal effervescens® (BG); Acetysal pH 8® (BG); Acid Acetilsalicilic® (RO); Acid Acetilsalicilic Tamponat® (RO); Acido Acetilsalicilico® (BR, CL, IT); Acido Acetilsali Diviser® (ES); Acido Acetilsal Mundogen® (ES); Acisalic® (RO); Acylpyrin® (CZ, SK); Adiro® (AR, CL, ES); Albyl® minor (SE); Albyl® (NO, SE); Albyl-Selters® (RO); Alcacyl Instant-Pulver® (CH); Algo-Bebe® (TR); Alidor® (BR); Alka-Seltzer® (AT, BE, BR, CH); Alka Seltzer® (CL); Alka-Seltzer® (CO, CZ); Alka Seltzer® (DE, ES); Alka-Seltzer® (FI, FR); Alka Seltzer® (HR); Alka-Seltzer® (HU); Alka Seltzer® (IL); Alka-Seltzer® (LU, NL, PL, PT, RO, RU, SE, SI, TR); Alka Seltzer® (YU); Amisprin® (BD); Ampiryna® (PL); Anbol® (YU); Andol® (HR, SI); Angettes® (GB); Anopyrin® (BG, CZ, PL, RU, SK); Apo-ASA® (CZ); Aristopirin® (EC); ASA 500® (MX); Asabrin® (TR); Asaflow® (BE, LU); Asaline® (RO); Asaphen (CA); Asaphen E.C. (CA); ASA® (PL); Asaprin® (RO); ASA-ratio ® (IT); ASA-Ratiopharm® (FI); Asarid® (BE, LU); ASA-Tabs® (CH); Ascard® (BD); Ascardia® (ID); Ascriptin® (IL); Asinpirine® (TR); ASL Normon® (ES); Asopiryna® (PL); Aspalgin® (SI); Aspegic® (BE); Aspégic® (CH); Aspegic® (CZ); Aspégic® (FR); Aspegic® (HU, IT, LU, MT); Aspegic Inject® [inj] (CH); Aspégic® (NL); Aspegic® (PL, PT, RO); Aspenter® (RO); Aspent-M® (TH); Aspent® (TH); Asperan® (BG); Aspicalcic® (RO); Aspicard® (DO); Aspicor® (YU); Aspidol® (IT); Aspikam® (RO); Aspilets® (HK, ID, TH); Aspimax® (RO); Aspimec® (ID); Aspinal® (TR); Aspinfantil® (ES); Aspi® (PL); Aspirem® (CY, JO); Aspiricor® (AT); Aspirina Asat® (AR); Aspirina Biocrom® (AR); Aspirina® (BR, CL, CO, ES, IT, PT); Aspirina Buffered® (BR); Aspirina Duncan® (AR); Aspirina Fabra® (AR); Aspirina Fecofar® (AR); Aspirina Ginsex® (AR); Aspirina Protect® (MX); Aspirina Richet® (AR); Aspirin® (AT, BG, CH, CY, CZ, DE, DK, EG, FI, GB, HK, HR, HU, IL, JO, KW, LB, MT, NL, NO, PL, RO, RU, SE, SI, TR, YU, ZA); Aspirina Vent-3® (AR); Aspirin Bayer® (BG, HR, ID, SG); Aspirin BD® (TH); Aspirin Cardio® (CH, FI, NO, RU); Aspirin Direct® (BG); Aspirin® Direkt (RO); Aspirine® (BE, LU, NL); Aspirine du Rh&ocirc;ne® (FR); Aspirine pH8® (FR); Aspirine Protect® (FR, NL); Aspirinetas® (AR); Aspirinetta® (IT); Aspirine UPSA® (FR); Aspirin Protect® (HU); Aspirin Rectal® (HK); Aspirin R® (RO); Aspirin Soluble® (ZA); Aspirin TAH® (BG); Aspirin Zipp® (FI); Aspirisucre® (FR); Aspisal® (BG); Aspisin® (BR); Aspisol® (DE); Aspotabs® (PL); Asprim® (DO); Aspro® (AT, AU, BE, CH, CZ, DE, FR, HU, IT, LU, NL, PT); Aspro Cardio® (NL); Aspro Clear® (GB, ZA); Asprocol® (PL); ASS 1A Pharma® (DE); ASS 100® (DE); ASS AL® (DE); ASS® (AT); ASS Atid® (DE); ASS dura® (DE); ASS gamma® (DE); ASS Genericon® (AT); ASS Heumann® (DE); ASS Hexal® (DE); ASS-Isis® (DE); ASS-Kreuz® (DE); ASS Lich® (DE); ASS light® (DE); ASS-L&uuml;nopharm® (DE); ASS-Mepha® (CH); ASS Molimin® (DE); ASS-ratiopharm® (AT, DE); ASS Sandoz® (DE); ASS Stada® (DE); ASS von ct® (DE); Astika® (ID); Astrix® (AU, CZ, HK, HU, SG); Ataspin® (TR); Babyprin® (TR); Baludon® (HR, SI); Bamyl® (SE); Bayaspirina® (AR); Bayaspirin® (JP); Bayer Aspirin® (AU, TH, ZA); Bestpirin® (PL); Be-Tabs Aspirin® (ZA); Bex® (AU); Bioplak® (ES); Bodrexin® (ID); Bokey EMC® (SG); Boots Seltzer® (GB); Bufferan® (RU); Buffered Aspirin® (IL); Bufferin® (CN, IT, SG); Caid® (BD); Callous® (PL); Caprin® (GB, IE); Cardegic® (BE, NL); Cardioaspirina® (AR, CL, CO); Cardioaspirine® (BE); Cardioaspirin® (IT); Cardiopirin® (PL); Cardiosolupsan® (FR); Cardiphar® (BE); Cardiprin 100® (AU); Cardirene® (IT); Cardoprin® (BD); Cartia® (AU, HK, IL, NZ, PT, RO); Cemirit® (IT); Ceto® (ID); Claragine® (FR); Colfarit® (HU); Contra-Schmerz ASS® (CH); Coralat® (DO); Cor-As-100® (YU); Coraspin® (TR); Coraspir® (MX); Corplus® (AR); Coryphen® (HK); Decitriol® (AR); Delgesic® (DE); Desenfriolito® (AR); Disperin® (FI); Dispril® (BE, LU, NO, TR); Disprin® (AU, GB, HK, IE, SG, ZA); Dolean pH 8® (RO); Dominal® (CL); Dusil® (SG); Ecasil® (BR); Ecopirin® (TR); Ecoprin® (IL); Ecosprin® (BD, IN); Ecotrin® (AR, CL, HK, IL, MX, NZ, ZA); Effervescent Pain Relief® (RO); Egalgic® (AR); Emotpin® (SE); Encopirin® (PL); Encoprin-LD® (BD); Encopyrin® (BD); Endosalil® (BR); Entrarin® (TH); Entrophen® (CA); Europirin® (RO); Europirin T® (RO); Farmasal® (ID); Flectadol® (IT); Galocard® (PL); G-Aspirin® (BD); Genasprin® (BD); Gencardia® (GB); Geniol® (AR); Globoid® (NO); Godamed® (DE, IL); Grippesin® (AR); Hassapirin-Puro® (CL); Helver Sal® (ES); Herron Aspirin® (AU); Herz ASS® (AT); HerzASS-ratiopharm® (DE, LU); Herzschutz ASS ratiopharm® (AT); Hjerdyl® (DK); Hjertemagnyl® (DK); Hl-Pain® (RU); Huma-ASA® (HU); Idotyl® (DK); IMA Acido Acetilsalicilico® (BR); Inyesprin® (ES); Inyesprin Forte® (EC); Isaspin® (TR); Istopirin® (HU); Juridin® (CH); Kalipyrin Lite® (BG); Kardégic® (CH, FR); Kardiren® (HU); Kilios® (IT); Laspal® (PL, RU); Lisaspin® (PT); Lo-Aspirin® (ZA); Lowasa® (IE); Lysinotol® (ES); Lysodrop® (BE); Lysoprin® (IL); Magnecyl brus® (SE); Magnecyl® (SE); Magnyl Dak® (DK); Magnyl SAD® (DK); Medibudget Schmerztabletten ASS® (CH); Mejoral Infantil® (ES); Mejoral Masticable® (ES); Melhoral® (BR); Melhoral Infantil® (BR); Meted® (IE); Micropirin® (GB); Midol® (YU); Migraspirina® (PT); Miniasal® (DE); Miraspryn® (PL); Myoprin® (ZA); Naspro® (ID); New Asper® (BG); Nipas® (PL); N&ouml;tras® (TR); Novasen (CA, PL); Novaspryn® (PL); Nu-Seals® (BG, GB, IE, RO, SI); Okal Infantil® (ES); Opon® (TR); Orravina® (ES); Pharmapirin® (RO); Pharmapirin T® (RO); Pharmasprin® (TR); Plidol® (RU); Polocard® (PL); Polopiryna® (PL); PostMI 75EC® (GB); Primaspan® (BE, FI); Procardin® (ID); Proficar® (PL); Rectocetil® (BR); Resprin® (IE); Restor® (ID); Rhodine® (AR, BE, LU); Rhonal® (AR, BG, ES, LU); Rhonalito® (AR); Rutonal® (CL); Salic® (BR); Salicilina® (PT); Salipads® (BR); Salpirin® (PL); Salvequick® (PL); Santapirin® (RO); Santasal N® (DE); Saspryl® (ES, IL); Seal and Heal® (PL); Sedergine® (BE, ES); Seferin® (TH); Solprin® (AU, NZ); Solrin® (BD); Solupsa® (LU); Solusal® (ID); Solusprin® (ES); Spren® (AU); Tamprim® (RO); Tampyrine® (BE, LU); Tevapirin® (IL); Therasa® (BE); Thomapyrin® (AT); Thrombace® (CH); Thrombo AS® (CL); Thrombo Aspilets® (ID); Thrombo ASS® (AT, BG, PL, RO, RU); Thrombostad® (AT); Tiatral SR® (CH); Togal ASS® (CH, DE, PL); Togal® (LU); Togal Mono® (AT); Toldex® (PT); Treo® (AT, SE); Tromalyt® (CO, ES); Trombyl® (SE); Upsalgine® (LU); Upsarin® (BG, CZ, PL, RO); V-As® (TH); Vincent's Powders® (AU); Yectaspirin® (AR)


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