Category:

• Miscellaneous

Description:

• Nonnarcotic analgesic, anti-inflammatory, antiplatelet agent, antipyretic

Indications:

• Mild to moderated pain/fever, inflammatory conditions such as rheumatoid arthritis and osteoarthritis, rheumatic fever

• Thromboembolic disorders

• Reducing risk of transient ischemic attacks; reducing risk of death or nonfatal MI in patients with previous MI or unstable angina

Contraindications:

• Hypersensitivity to salicylates, NSAIDs, or tartrazine (FDA yellow dye #5)

• GI bleeding, hemophilia, hemorrhagic states

Precautions:

• Pregnancy category C (D in full doses during 3^rd trimester)

• Anemia, asthma, nasal polyps, nasal allergies, hepatic disease, renal disease

• Pre/postoperatively, children/teenagers with flu-like symptoms (may be associated with the development of Reye’s syndrome)

• Gout, history of coagulation defects, bleeding disorders

Adverse Reactions (Side Effects):

• CNS: confusion, dizziness, drowsiness, headache

• EENT: dimness of vision, reversible hearing loss, tinnitus

• GI: acute reversible hepatotoxicity, anorexia, cholestasis, dyspepsia, epigastric discomfort, GI bleeding, heartburn, nausea, increased aminase levels

• HEME: hyperuricemia (low dose), hyperuricemia (high dose), leukopenia, prolonged bleeding time, shortened erythrocyte survival time, thrombocytopenia

• METAB: hypoglycemia, hypokalemia, hyponatremia

• RESP: hyperpnea, wheezing

• SKIN: angioedema, bruising, hives, rash, urticaria

Dosage:

Administered orally and rectally

• Adult:            

  • Arthritis: PO 2.6-5.2 g/day in divided doses every 4-6 hours

  • Pain/fever: PO/PR 325-650mg every 4 hours as needed, not to exceed 4g daily

  • Transient ischemic attacks:

    • 325-650mg 1-2 times daily (325mg daily may be as effective as larger doses and associated with fewer side effects)

  • MI prophylaxis: PO 165-325mg daily

• Child:            

  • Arthritis: PO 60-90 mg/kg per day in divided doses; usually maintenance dose 80-100 mg/kg daily divided every 6-8 hours; maintain serum salicylate level of 150-300 mcg/ml

  • Pain/fever: PO/PR 10-15 mg/kg per dose every 4-6 hours as needed

Drug Interactions:

• Methotrexate: increased serum concentration and enhanced methotrexate toxicity

• Oral anticoagulants: increased risk of bleeding by inhibiting platelet function and possibly by producing gastric erosions

• Warfarin: enhanced hypoprothrombinemic effect of warfarin

Note:

• Not to be given to children with flu-like symptoms, Reye’s syndrome may develop

• Therapeutic response may take two weeks (arthritis)

• Administer with food

Bureau of Medicine and Surgery
Department of the Navy
2300 E Street NW
Washington, D.C
20372-5300

Operational Medicine
 Health Care in Military Settings
CAPT Michael John Hughey, MC, USNR
NAVMED P-5139
  January 1, 2001