AMOXICILLIN

Brand names: Amoxil, Trimox, Wymox

Amoxicillin, formerly amoxycillin, is a moderate-spectrum, bacteriolytic, β-lactam antibiotic
used to treat bacterial infections caused by susceptible microorganisms. Amoxicillin is used to
treat many different types of infections caused by bacteria, such as ear infections, bladder
infections, pneumonia, gonorrhea, and E. coli or salmonella infection. Amoxicillin is an
antibiotic in the penicillin group of drugs.

Generic Amoxil 500mg

Package Price Per Pill Order

500mg × 60 pills $ 88.95 US $ 1.48

500mg × 90 pills $ 125.95 US $ 1.40

500mg × 120 pills $ 159.95 US $ 1.33

500mg × 180 pills $ 229.95 US $ 1.28

500mg × 360 pills $ 449.95 US $ 1.25

Generic Trimox 500mg

Package Price Per Pill Order

500mg × 30 pills $ 45.95 US $ 1.53

500mg × 60 pills $ 88.95 US $ 1.48

500mg × 90 pills $ 125.95 US $ 1.40

500mg × 120 pills $ 159.95 US $ 1.33

500mg × 180 pills $ 229.95 US $ 1.28

What are amoxicillin capsules, tablets or chewable tablets?

AMOXICILLIN (Amoxil®, Trimox®, Wymox®) is a penicillin antibiotic. Amoxicillin kills or

stops the growth of bacteria that cause infection. It treats many different kinds of infections of
the skin, respiratory tract, sinuses, ear, and kidney. Amoxicillin also treats some sexually
transmitted disease.

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:

asthma
eczema
kidney disease
leukemia
mononucleosis
intestinal problems (especially colitis)
other chronic illness
phenylketonuria
viral infection
an unusual or allergic reaction to amoxicillin, other penicillins, cephalosporin antibiotics, other
medicines, foods, dyes, or preservatives
breast-feeding

How should I take this medicine?

Take amoxicillin capsules, tablets, or chewable tablets by mouth. Swallow the regular capsules
or tablets whole with a glass of water; take while in an upright or sitting position. Chew or crush
the chewable tablets, do not swallow whole. You may take amoxicillin with or without food.
Follow the directions on the prescription label. Take your doses at regular intervals. Do not take
your medicine more often than directed. Finish the full course prescribed by your prescriber or
health care professional even if you think your condition is better. Do not stop taking except on
your prescriber's advice.

What side effects may I notice from taking amoxicillin?

Side effects that you should report to your prescriber or health care professional as soon as
possible:
difficulty breathing, wheezing
dark yellow or brown urine
dizziness
fever or chills, sore throat
increased thirst
pain or difficulty passing urine
pain on swallowing
redness, blistering, peeling or loosening of the skin, including inside the mouth
seizures (convulsions)
skin rash, itching
stomach pain or cramps
swollen joints
severe or watery diarrhea
unusual bleeding or bruising
unusual weakness or tiredness
vomiting
yellowing of the eyes or skin

Side effects that usually do not require medical attention (report to your prescriber or health care
professional if they continue or are bothersome):
diarrhea
headache
loss of appetite
nausea
stomach gas or heartburn

What should I watch for while taking amoxicillin?

Tell your prescriber or health care professional if your symptoms do not improve in 2 or 3 days.

If you are diabetic and taking large doses of amoxicillin, you may get a false-positive result for
sugar in your urine with certain brands of urine tests. Check with your prescriber or health care
professional before you change your diet or the dose of your diabetic medicine.

If you get severe or watery diarrhea, do not treat yourself. Call your prescriber or health care
professional for advice.

If you get a skin rash, do not treat yourself. Call your prescriber or health care professional for
advice.

Amox

ADVERSE REACTIONS

As with other penicillins, it may be expected that untoward reactions will be essentially limited
to sensitivity phenomena. They are more likely to occur in individuals who have previously
demonstrated hypersensitivity to penicillins and in those with a history of allergy, asthma, hay
fever, or urticaria. The following adverse reactions have been reported as associated with the use
of penicillins:

Infections and Infestations

Mucocutaneous candidiasis.

Gastrointestinal

Nausea, vomiting, diarrhea, black hairy tongue, and hemorrhagic/pseudomembranous colitis.

Onset of pseudomembranous colitis symptoms may occur during or after antibiotic treatment.
(See WARNINGS.)

Hypersensitivity Reactions

Anaphylaxis (See WARNING)

Serum sickness−like reactions, erythematous maculopapular rashes, erythema multiforme,

Stevens-Johnson syndrome, exfoliative dermatitis, toxic epidermal necrolysis, acute generalized
exanthematous pustulosis, hypersensitivity vasculitis and urticaria have been reported.

NOTE: These hypersensitivity reactions may be controlled with antihistamines and, if

necessary, systemic corticosteroids. Whenever such reactions occur, amoxicillin should be
discontinued unless, in the opinion of the physician, the condition being treated is life-
threatening and amenable only to amoxicillin therapy.

Liver

A moderate rise in AST (SGOT) and/or ALT (SGPT) has been noted, but the significance of this
finding is unknown. Hepatic dysfunction including cholestatic jaundice, hepatic cholestasis and
acute cytolytic hepatitis have been reported.

Renal

Crystalluria has also been reported (see OVERDOSAGE).

Hemic and Lymphatic Systems

Anemia, including hemolytic anemia, thrombocytopenia, thrombocytopenic purpura,

eosinophilia, leukopenia, and agranulocytosis have been reported during therapy with penicillins.
These reactions are usually reversible on discontinuation of therapy and are believed to be
hypersensitivity phenomena.

Central Nervous System

Reversible hyperactivity, agitation, anxiety, insomnia, confusion, convulsions, behavioral

changes, and/or dizziness have been reported rarely.

Miscellaneous

Tooth discoloration (brown, yellow, or gray staining) has been rarely reported. Most reports
occurred in pediatric patients. Discoloration was reduced or eliminated with brushing or dental
cleaning in most cases.
Cotrimoxazole

What is Cotrimoxazole?

 Cotrimoxazole is an antibiotic that treats different types of bacterial infections. It fights bacteria
in your body.
 Cotrimoxazole is used to treat infections such as urinary tract infections, bronchitis, ear
infections (otitis), traveler’s diarrhea, and Pneumocystis carinii pneumonia.
 Cotrimoxazole may also be used for purposes other than those listed in this medication guide.

What should I avoid while taking sulfamethoxazole and trimethoprim?

 Avoid prolonged exposure to sunlight. Cotrimoxazole may increase the sensitivity of your skin to
sunlight. Use a sunscreen and wear protective clothing when exposure to the sun is
unavoidable.

What are the possible side effects of Cotrimoxazole?

 Stop taking the drug and seek emergency medical attention if you experience any of the
following serious side effects:
o an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips,
tongue, or face; or hives);
o unusual bleeding or bruising; or
o yellow skin or eyes.
 Other, less serious side effects may be more likely to occur. Continue to take your medication
and talk to your doctor if you experience
o headache, fatigue, or dizziness;
o nausea, vomiting, decreased appetite, or diarrhea;
o weakness; or
o increased sensitivity to the sun.
 Side effects other than those listed here may also occur. Talk to your doctor about any side
effect that seems unusual or that is especially bothersome.

CLASSIFICATION

Antibacterial

ALTERNATE NAMES

BACTRIM, SEPTRA

 INDICATIONS

 treatment of infections due to susceptible organisms

 RECONSTITUTION AND STABILITY

  dilute each 5 mL ampoule with 125 mL of D5W or NS, the prepared solution must be kept at room
temperature (solution stable for 24 hours)
 in fluid restriction:  each 5 mL ampoule may be diluted with 75 mL D5W or NS (solution stable for a total
of 3 hours, inluding infusion period)
 each 5 mL ampoule may be diluted with 50mL D5W or NS (solution stable for a total of 1.5 hours,
including infusion period)
 discard if there is cloudiness or precipitation

 COMPATIBILITY

 compatible with D5W (preferred), NS, RS

 compatible via Y-site with acyclovir, cyclosporine, hydromorphone, lorazepam, magnesium sulphate,
meperidine, morphine, multivitmins, piperacillin-tazobactam, potassium chloride
 incompatible with other drugs

 ROUTES OF ADMINISTRATION

 IV intermittent - over 30-60 minutes

 VH & HSC ADMINISTRATION POLICY

A - Not to be administered by the direct IV route.

 DOSAGE

Cotrimoxazole is a fixed combination product containing sulfamethoxazole and trimethoprim in 5:1 ratio.

Pneumocystis Carinii Pneumonia:

 Adults and children: 5 mg/kg trimethoprim (as cotrimoxazole) every 6 hours

Gram-Negative Sepsis:

 Adults: 2.5 mg/kg trimethoprim (as cotrimoxazole) every 6 hours

 Dosage interval must be lengthened in renal impairment: (2.5-5 mg/kg/dose)

Creatinine Clearance (mL/minute) Dosage Interval

30 - 50 every 8 hours
< 30 every 12 hours

POTENTIAL HAZARDS OF PARENTERAL ADMINISTRATION

 hypersensitivity reactions
 pain, local irritation, inflammation, and rarely thrombophlebitis

 IMPORTANT IMPLICATIONS

 hematologic toxicity:  neutropenia, thrombocytopenia, agranulocytosis, aplastic anemia

  contraindicated in patients with known hypersensitivity to trimethoprim or sulfonamides, or with
documented megaloblastic anemia secondary to folate deficiency
 use with caution in patients with impaired renal or hepatic function or with possible folate or G-6-PD
deficiency

What is Ambroxol?
<script type="text/javascript" charset="ISO-8859-1"
src="http://as.webmd.com/js.ng/Params.richmedia=yes&amp;transactionID=73678741&amp;tile=7367
8741&amp;site=2&amp;affiliate=38&amp;xpg=4292&amp;pos=121"></script>

Ambroxol is a clinically proven systemically active mucolytic agent. When administered orally
onset of action occurs after about 30 minutes. The breakdown of acid mucopolysaccharide fibers
makes the sputum thinner and less viscous and therefore more easily removed by coughing.
Although sputum volume eventually decreases, its viscosity remains low for as long as treatment
is maintained.

Ambroxol Indications

All forms of tracheobronchitis, emphysema with bronchitis pneumoconiosis, chronic

inflammatory pulmonary conditions, bronchiectasis, bronchitis with bronchospasm asthma.
During acute exacerbations of bronchitis it should be given with the appropriate antibiotic.

Ambroxol Contraindications
There are no absolute contraindications but in patients with gastric ulceration relative caution should be
observed.

Ambroxol hydrochloride is a strong expectorant used to treat upper respiratory tract infections
and other lung problems, including chronic inflammatory pulmonary conditions; it clears the
airway and makes coughing more productive. Ambroxol can be purchased under several brand
names and in generic form, but it is not available in North America.

Gastrointestinal Side Effects

1. The most common side effects associated with ambroxol are gastrointestinal, including diarrhea,
heartburn, indigestion, and occasionally nausea and vomiting.

Unlikely Side Effects

2. Unlikely ambroxol side effects include dry mouth, headache, painful urination, persistent runny
nose and weakness.
 Allergic Reactions

3. Allergic reactions to ambroxol have occurred rarely and mainly involve skin rashes, hives and
dermatitis, as well as possible swelling.

Anaphylactic Reactions

4. Extremely rare cases have been reported of severe acute anaphylactic reactions, but researchers
have been unable to determine if these are actually related to ambroxol use or to some other
factor.

Intravenous Side Effects

5. Intravenous ambroxol has been associated with chills, intense headaches, shortness of breath
and weakness.

Ambroxol Side effects

Occasional gastrointestinal side effects may occur but these are normally mild.

Precautions

It is advisable to avoid use during the first trimester of pregnancy.

Ambroxol Dosage

Adults: daily dose of 30 mg (one Ambroxol tablet )to 120 mg (4 Ambroxol tablets) taken in 2 to
3 divided doses

Children up to 2 years: half a teaspoonful Ambroxol syrup twice daily

Children 2 - 5 years: half a teaspoonful Ambroxol syrup 3 times daily

Children over 5 years: One teaspoonful Ambroxol syrup 2-3 times daily.

Storage

Store at a temperature not exceeding 30 degrees celsius.

Keep all medicine out of reach of children.

How Supplied

Box of 10 ,1000 tablets.

Syrup - bottles of 60 ml, 120 ml.

What is cloxacillin?
<script type="text/javascript" charset="ISO-8859-1"
src="http://as.webmd.com/js.ng/Params.richmedia=yes&amp;transactionID=14113454&amp;tile=1411
3454&amp;site=2&amp;affiliate=38&amp;xpg=4286&amp;pos=121"></script>

Cloxacillin is an antibiotic in the class of drugs called penicillins. It fights bacteria in your body.

Cloxacillin is used to treat many different types of infections caused by staphylococcus bacteria
("staph" infections).

Cloxacillin may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about cloxacillin?

Take all of the cloxacillin that has been prescribed for you even if you begin to feel better. Your
symptoms may begin to improve before the infection is completely treated. Do not break, chew, open,
or crush the capsules. Swallow them whole. Cloxacillin may decrease the effectiveness of birth control
pills. Use a second method of birth control while taking cloxacillin to protect against pregnancy.

Who should not take cloxacillin?

If you have ever had an allergic reaction to another penicillin or to a cephalosporin, do not take
cloxacillin unless your doctor is aware of your allergy and monitors your therapy.

Before taking this medication, tell your doctor if you have kidney disease, stomach or intestinal
disease, or infectious mononucleosis. You may not be able to take cloxacillin because of an
increased risk of side effects.

If you are a diabetic, some glucose urine tests may give false positive results while you are
taking cloxacillin.

Cloxacillin is in the FDA pregnancy category B. This means that it is unlikely to harm an unborn baby. Do
not, however, take cloxacillin without first talking to your doctor if you are pregnant. It is not known
whether cloxacillin passes into breast milk. Do not take this medication without first talking to your
doctor if you are breast-feeding a baby.

albuterol (salbutamol)

Proventil, Ventolin

Pharmacologic class: Sympathomimetic (beta2-adrenergic agonist)

Therapeutic class: Bronchodilator, antiasthmatic

Pregnancy risk category C

Action

Relaxes smooth muscles by stimulating beta2-receptors, thereby causing bronchodilation and

vasodilation

Availability

Aerosol: 90 mcg/actuation

Oral solution: 2 mg/5 ml

Solution for inhalation: 0.083% (3 ml), 0.5% (0.5 and 20 ml), 0.63 mg/3 ml, 1.25 mg/3 ml

Syrup: 2 mg/5 ml

Tablets: 2 mg, 4 mg

Tablets (extended-release): 4 mg, 8 mg

⊘Indications and dosages

➣ To prevent and relieve bronchospasm in patients with reversible obstructive airway disease
Adults and children ages 12 and older: Tablets - 2 to 4 mg P.O. three or four times daily, not
to exceed 32 mg daily. Extended-release tablets - 4 to 8 mg P.O. q 12 hours, not to exceed 32 mg
daily in divided doses. Syrup - 2 to 4 mg (1 to 2 tsp or 5 to 10 ml) three or four times daily, not to
exceed 8 mg q.i.d. Aerosol - one to two inhalations q 4 to 6 hours to relieve bronchospasm; two
inhalations q.i.d. to prevent bronchospasm. Solution for inhalation - 2.5 mg three to four times
daily by nebulization, delivered over 5 to 15 minutes.

Children ages 6 to 12: Tablets - 2 mg P.O. three or four times daily; maximum daily dosage is
24 mg, given in divided doses. Extended-release tablets - 4 mg q 12 hours; maximum daily
dosage is 24 mg/kg given in divided doses. Syrup - 2 mg (1 tsp or 5 ml) three or four times daily,
not to exceed 24 mg.

Children ages 2 to 12 weighing more than 15 kg (33 lb): Solution for inhalation - 2.5 mg three
to four times/day by nebulization

Children ages 2 to 6: Syrup - Initially, 0.1 mg/kg P.O. t.i.d., not to exceed 2 mg (1 tsp) t.i.d.
Maximum dosage is 4 mg (2 tsp) t.i.d.
➣ To prevent exercise-induced bronchospasm
Adults and children older than age 4 (older than age 12 with Proventil): Two inhalations 15
minutes before exercise

Dosage adjustment

• Sensitivity to beta-adrenergic stimulants

• Elderly patients

Off-label uses

• Chronic obstructive pulmonary disease

• Hyperkalemia with renal failure
• Preterm labor management

Contraindications

• Hypersensitivity to drug

Precautions

Use cautiously in:

• cardiac disease, hypertension, diabetes mellitus, glaucoma, seizure disorder, hyperthyroidism,
exercise-induced bronchospasm, prostatic hypertrophy
• elderly patients
• pregnant or breastfeeding patients
• children.

Administration

• Give extended-release tablets whole; don't crush or mix with food.

• Administer solution for inhalation by nebulization over 5 to 15 minutes, after diluting 0.5 ml of
0.5% solution with 2.5 ml of sterile normal saline solution.
• Know that children weighing less than 15 kg (33 lb) who require less than 2.5 mg/dose should
receive 0.5% inhalation solution.

Route Onset Peak Duration

P.O. 15-30 min 2-3 hr 6-12 hr

P.O. (extended) 30 min 2-3 hr 12 hr

Adverse reactions

CNS: dizziness, excitement, headache, hyperactivity, insomnia

CV: hypertension, palpitations, tachycardia, chest pain

EENT: conjunctivitis, dry and irritated throat, pharyngitis

GI: nausea, vomiting, anorexia, heartburn, GI distress, dry mouth

Metabolic: hypokalemia

Musculoskeletal: muscle cramps

Respiratory: cough, dyspnea, wheezing, paradoxical bronchospasm

Skin: pallor, urticaria, rash, angioedema, flushing, sweating

Other: tooth discoloration, increased appetite, hypersensitivity reaction

Interactions

Drug-drug. Beta-adrenergic blockers: inhibited albuterol action, possibly causing severe

bronchospasm in asthmatic patients

Digoxin: decreased digoxin blood level

MAO inhibitors: increased cardiovascular adverse effects

Oxytoxics: severe hypotension

Potassium-wasting diuretics: ECG changes, hypokalemia

Theophylline: increased risk of theophylline toxicity

Drug-food. Caffeine-containing foods and beverages (such as coffee, tea, chocolate): increased
stimulant effect

Drug-herbs. Cola nut, ephedra (ma huang), guarana, yerba maté: increased stimulant effect

Patient monitoring

☞ Stay alert for hypersensitivity reactions and paradoxical bronchospasm. Stop drug
immediately if these occur.
• Monitor serum electrolyte levels.
Patient teaching

• Tell patient to swallow extended-release tablets whole and not to mix them with food.
☞ Teach patient signs and symptoms of hypersensitivity reaction and paradoxical
bronchospasm. Tell him to stop taking drug immediately and contact prescriber if these occur.
☞ Instruct patient to notify prescriber immediately if prescribed dosage fails to provide usual
relief, because this may indicate seriously worsening asthma.
• Advise patient to limit intake of caffeine-containing foods and beverages and to avoid herbs
unless prescriber approves.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects
concentration and alertness.
• Advise patient to establish effective bedtime routine and to take drug well before bedtime to
minimize insomnia.
• As appropriate, review all other significant and life-threatening adverse reactions and
interactions, especially those related to the drugs, foods, and herbs mentioned above.

Aspirin 

Definition
Aspirin is a medicine that relieves pain and reduces fever.

Purpose
Aspirin is used to relieve many kinds of minor aches and pains—headaches, toothaches, muscle pain,
menstrual cramps, the joint pain from arthritis, and aches associated with colds and flu. Some people
take aspirin daily to reduce the risk of stroke, heart attack, or other heart problems.

Description
Aspirin-also known as acetylsalicylic acid-is sold over the counter and comes in many forms, from the
familiar white tablets to chewing gum and rectal suppositories. Coated, chewable, buffered, and
extended release forms are available. Many other over-the-counter medicine contain aspirin. Alka-
Seltzer Original Effervescent Antacid Pain Reliever, for example, contains aspirin for pain relief and
sodium bicarbonate to relieve acid indigestion, heartburn, and sour stomach.

Aspirin belongs to a group of drugs called salicylates. Other members of this group include sodium
salicylate, choline salicylate, and magnesium salicylate. These drugs are more expensive and no more
effective than aspirin. However, they are a little easier on the stomach. Aspirin is quickly absorbed into
the bloodstream and provides quick and relatively long-lasting pain relief. Aspirin also reduces
inflammation. Researchers believe these effects come about because aspirin blocks the production of
pain-producing chemicals called prostaglandins.

In addition to relieving pain and reducing inflammation, aspirin also lowers fever by acting on the part of
the brain that regulates temperature. The brain then signals the blood vessels to widen, which allows
heat to leave the body more quickly.
Recommended dosage

Adults
TO RELIEVE PAIN OR REDUCE FEVER. One to two tablets every three to four hours, up to six times per
day.

TO REDUCE THE RISK OF STROKE. One tablet four times a day or two tablets twice a day.

TO REDUCE THE RISK OF HEART ATTACK. Check with a physician for the proper dose and number of
times per week aspirin should, if at all, be taken.

Children
Check with a physician.

Precautions
Aspirin-even children's aspirin-should never be given to children or teenagers with flu-like symptoms or
chickenpox. Aspirin can cause Reye's syndrome, a life-threatening condition that affects the nervous
system and liver. As many as 30% of children and teenagers who develop Reye's syndrome die. Those
who survive may have permanent brain damage.

Check with a physician before giving aspirin to a child under 12 years for arthritis, rheumatism, or any
condition that requires long-term use of the drug.

No one should take aspirin for more than 10 days in a row unless told to do so by a physician. Anyone
with fever should not take aspirin for more than 3 days without a physician's consent. Do not to take
more than the recommended daily dosage.

Key terms
Diuretic — Medicine that increases the amount of urine produced and relieves excess fluid buildup in
body tissues. Diuretics may be used in treating high blood pressure, lung disease, premenstrual
syndrome, and other conditions.

Inflammation — Pain, redness, swelling, and heat that usually develop in response to injury or illness.

NSAIDs — Nonsteroidal anti-inflammatory drugs. Drugs such as ketoprofen and ibuprofen which relieve
pain and reduce inflammation.

Polyp — A lump of tissue protruding from the lining of an organ, such as the nose, bladder, or intestine.
Polyps can sometimes block the passages in which they are found.

Prostaglandin — A hormonelike chemical produced in the body. Prostaglandins have a wide variety of
effects, and may be responsible for the production of some types of pain and inflammation.

Reye's syndrome — A life-threatening disease that affects the liver and the brain and sometimes occurs
after a viral infection, such as flu or chickenpox. Children or teenagers who are given aspirin for flu or
chickenpox are at increased risk of developing Reye's syndrome.
Rhinitis — Inflammation of the membranes inside the nose.

Salicylates — A group of drugs that includes aspirin and related compounds. Salicylates are used to
relieve pain, reduce inflammation, and lower fever.

People in the following categories should not use aspirin without first checking with their physician:

 Pregnant women. Aspirin can cause bleeding problems in both the mother and the developing
fetus. Aspirin can also cause the infant's weight to be too low at birth.
 Women who are breastfeeding. Aspirin can pass into breast milk and may affect the baby.

 People with a history of bleeding problems.

 People who are taking blood-thinning drugs, such as warfarin (Coumadin).
 People with a history of ulcers.
 People with a history of asthma, nasal polyps, or both. These people are more likely to be
allergic to aspirin.
 People who are allergic to fenoprofen, ibuprofen, indomethacin, ketoprofen, meclofenamate
sodium, naproxen, sulindac, tolmetin, or the orange foodcoloring tartrazine. They may also be
allergic to aspirin.
 People with AIDS or AIDS-related complex who are taking AZT (zidovudine). Aspirin can increase
the risk of bleeding in these patients.
 People taking certain other drugs (discussed in Interactions).
 People with liver damage or severe kidney failure.

Aspirin should not be taken before surgery, as it can increase the risk of excessive bleeding. Anyone who
is scheduled for surgery should check with his or her surgeon to find out how long before surgery to
avoid taking aspirin.
Aspirin can cause stomach irritation. To reduce the likelihood of that problem, take aspirin with food or
milk or drink a full 8-oz glass of water with it. Taking coated or buffered aspirin can also help. Be aware
that drinking alcohol can make the stomach irritation worse.

Stop taking aspirin immediately and call a physician if any of these symptoms develop:

 ringing or buzzing in the ears

 hearing loss
 dizziness
 stomach pain that does not go away

Do not take aspirin that has a vinegary smell. That is a sign that the aspirin is too old and ineffective.
Flush such aspirin down the toilet.
Because aspirin can increase the risk of excessive bleeding, do not take aspirin daily over long periods-to
reduce the risk of stroke or heart attack, for example-unless advised to do so by a physician.

Side effects
The most common side effects include stomachache, heartburn, loss of appetite, and small amounts of
blood in stools. Less common side effects are rashes, hives, fever, vision problems, liver damage, thirst,
stomach ulcers, and bleeding. People who are allergic to aspirin or those who have asthma, rhinitis, or
polyps in the nose may have trouble breathing after taking aspirin.

Interactions
Aspirin may increase, decrease, or change the effects of many drugs. Aspirin can make drugs such as
methotrexate (Rheumatrex) and valproic acid (Depakote, Depakene) more toxic. If taken with blood-
thinning drugs, such as warfarin (Coumadin) and dicumarol, aspirin can increase the risk of excessive
bleeding. Aspirin counteracts the effects of other drugs, such as angiotensin-converting enzyme (ACE)
inhibitors and beta blockers, which lower blood pressure, and medicines used to treat gout (probenecid
and sulfinpyrazone). Blood pressure may drop unexpectedly and cause fainting or dizziness if aspirin is
taken along with nitroglycerin tablets. Aspirin may also interact with diuretics, diabetes medicines, other
nonsteroidal anti-inflammatory drugs (NSAIDs), seizure medications, and steroids. Anyone who is taking
these drugs should ask his or her physician whether they can safely take aspirin.

Resources

Periodicals
"What's the Best Pain Reliever? Depends on Your Pain." Consumer Reports May 1996: 62.

Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.

aspirin /as·pi·rin/ (as´pĭ-rin) acetylsalicylic acid, a nonsteroidal antiinflammatory drug having analgesic,
antipyretic, antiinflammatory, and antirheumatic activity; also an inhibitor of platelet aggregation.

Dorland's Medical Dictionary for Health Consumers. © 2007 by Saunders, an imprint of Elsevier, Inc. All
rights reserved.

as·pi·rin ( s p r- n, -pr n)

n.

A white, crystalline compound derived from salicylic acid and commonly used to relieve pain and reduce
fever and inflammation. It is also used as an antiplatelet agent. Also called acetylsalicylic acid.

The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company.
Published by Houghton Mifflin Company. All rights reserved.

aspirin (ASA)

[as′pirin]
an analgesic, antipyretic, and antiinflammatory. Also called acetylsalicylic acid.

indications It is prescribed to reduce fever and relieve pain and inflammation.

contraindications Bleeding disorders, peptic ulcer, pregnancy, concomitant use of anticoagulants, or

known hypersensitivity to salicylates prohibit its use.

adverse effects Among the most serious adverse reactions are ulcers, occult bleeding, clotting defects,
renal toxicities, tinnitus, dyspepsia, and allergic reactions. Reye's syndrome has been associated with
aspirin use in children.

Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier.

aspirin,

n brand names: ASA, Aspirin, Ecotrin;

drug class: nonnarcotic analgesic salicylate;
action: inhibits prostaglandin synthesis, possesses analgesic, antiinflammatory, antipyretic properties;
uses: mild to moderate pain or fever. It was the first discovered member of the class of drugs known as
nonsteroidal antiinflammatory drugs (NSAIDs), not all of which are salicylates, although they all have
similar effects and a similar action mechanism. Its primary undesirable side effects, especially in stronger
doses, are gastrointestinal distress (including ulcers and stomach bleeding) and tinnitus. Another side
effect, due to its anticoagulant properties, is increased bleeding.

aspirin burn,

n See burn, aspirin.

aspirin, phenacetin, caffeine (APC, PAC)

n a pharmaceutical preparation used as an analgesic.

Mosby's Dental Dictionary, 2nd edition. © 2008 Elsevier, Inc. All rights reserved.

aspirin

acetylsalicylic acid, a common drug generally used to relieve pain and reduce fever.

aspirin poisoning
occurs in dogs and cats, either from accidental ingestion or inappropriate therapeutic doses. The cat is
particularly susceptible because of its limited ability to form glucaronide conjugates. Clinical signs are of
a hemorrhagic gastritis, hyperexcitability and metabolic acidosis.

Saunders Comprehensive Veterinary Dictionary, 3 ed. © 2007 Elsevier, Inc. All rights reserved

acetylsalicylic acid (aspirin)

Alka (UK), Angettes (UK), Apo-Asa (CA), Apo-ASEN (CA), Arthrinol (CA), Arthrisin (CA),
Artria S.R. (CA), ASA, Aspergum, Aspercin, Aspir-Low, Astrin (CA), Bayer, Caprin (UK),
Coryphen (CA), Dispirin (UK), Easprin, Ecotrin, Enpirin (UK), Entrophen (CA), Halfprin,
Headache Tablet (CA), Micoprin (UK), Novasen (CA), Nu-Seals (UK), PMS-ASA (CA),
PostMI (UK), Sal-Adult (CA), Sal-Infant (CA), St. Joseph, Supasa (CA), Sureprin, ZORprin

Pharmacologic class: Nonsteroidal anti-inflammatory drug (NSAID)

Therapeutic class: Nonopioid analgesic, antipyretic, antiplatelet drug

Pregnancy risk category C (with full dose in third trimester: D )

Action

Reduces pain and inflammation by inhibiting prostaglandin production. Fever reduction

mechanism unknown; may be linked to decrease in endogenous pyrogens in hypothalamus
resulting from prostaglandin inhibition. Exerts antiplatelet effect by inhibiting synthesis of
prostacyclin and thromboxane A2.

Availability

Gum (chewable): 227 mg

Suppositories: 60 mg, 120 mg, 200 mg, 300 mg, 325 mg, 600 mg, 650 mg

Tablets: 81 mg, 325 mg, 500 mg

Tablets (chewable): 81 mg

Tablets (enteric-coated, delayed-release): 81 mg, 162 mg, 325 mg, 500 mg, 650 mg, 975 mg

Tablets (extended-release): 650 mg, 800 mg

Tablets (film-coated): 325 mg, 500 mg

⊘Indications and dosages

➣ Mild pain or fever
Adults: 325 to 500 mg P.O. q 3 hours, or 325 to 650 mg P.O. q 4 hours, or 650 to 1,000 mg P.O.
q 6 hours, to a maximum dosage of 4,000 mg/day.

Extended-release tablets - 650 mg to 1,300 mg q 8 hours, not to exceed 3,900 mg/day; or 800 mg
q 12 hours.

Children: 10 to 15 mg/kg P.O. or P.R. q 4 hours, not to exceed total daily dosage of 3.6 g, or up
to 60 to 80 mg/kg/day. See chart below.

Age Dosage

12-14 years 648 mg q 4 hr

11-12 years 486 mg q 4 hr

9-10 years 405 mg q 4 hr

6-8 years 324 mg q 4 hr

4-5 years 243 mg q 4 hr

2-3 years 162 mg q 4 hr

Contraindications

• Hypersensitivity to salicylates, other NSAIDs, or tartrazine

• Renal impairment
• Severe hepatic impairment
• Hemorrhagic states or blood coagulation defects
• Vitamin K deficiency caused by dehydration
• Concurrent anticoagulant use
• Pregnancy (third trimester) or breastfeeding

Precautions

Use with extreme caution, if at all, in:

• hepatic disorders, anemia, asthma, gastritis, Hodgkin's disease
• heart failure or other conditions in which high sodium content is harmful (buffered aspirin)
• patients receiving other salicylates or NSAIDs concurrently
• elderly patients
• children and adolescents.
Administration

☞ Never administer to child or adolescent who has signs or symptoms of chickenpox or flulike
illness.
☞ Don't give within 6 weeks after administration of live varicella virus vaccine, because of risk
of Reye's syndrome.
• Give with food or large amounts of water or milk to minimize GI irritation.
• Know that extended-release and enteric-coated forms are best for long-term therapy.
• Be aware that aspirin should be discontinued at least 1 week before surgery because it may
inhibit platelet aggregation.

Route Onset Peak Duration

P.O. (tablets) 15-30 min 1-2 hr 4-6 hr

P.O. (chewable) Rapid Unknown 1-4 hr

P.O. (enteric-coated) 5-30 min 2-4 hr 8-12 hr

P.O. (extended) 5-30 min 1-4 hr 3-6 hr

P.R. 5-30 min 3-4 hr 1-4 hr

Adverse reactions

EENT: hearing loss, tinnitus, ototoxicity

GI: nausea, vomiting, abdominal pain, dyspepsia, epigastric distress, heartburn, anorexia, GI
bleeding

Hematologic: thrombocytopenia, hemolytic anemia, leukopenia, agranulocytosis, shortened

red blood cell life span

Hepatic: hepatotoxicity

Metabolic: hyponatremia, hypokalemia, hypoglycemia

Respiratory: wheezing, hyperpnea, pulmonary edema with toxicity

Skin: rash, urticaria, bruising, angioedema

Other: hypersensitivity reactions, salicylism or acute toxicity

Interactions

Drug-drug. Acidifying drugs (such as ammonium chloride): increased salicylate blood level

Activated charcoal: decreased salicylate absorption

Alkalinizing drugs (such as antacids): decreased salicylate blood level

Angiotensin-converting enzyme (ACE) inhibitors: decreased antihypertensive effect

Anticoagulants, NSAIDs, thrombolytics: increased bleeding risk

Carbonic anhydrase inhibitors (such as acetazolamide): salicylism

Corticosteroids: increased salicylate excretion and decreased blood level

Furosemide: increased diuretic effect

Live varicella virus vaccine: increased risk of Reye's syndrome

Methotrexate: decreased methotrexate excretion and increased blood level, causing greater risk
of toxicity

Nizatidine: increased salicylate blood level

Spironolactone: decreased spironolactone effect

Sulfonylureas (such as chlorpropamide, tolbutamide): enhanced sulfonylurea effects

Tetracycline (oral): decreased absorption of tetracycline (with buffered aspirin)

Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, amylase, aspartate

aminotransferase, coagulation studies, PaCO2, uric acid: increased values

Cholesterol, glucose, potassium, protein-bound iodine, sodium, thyroxine, triiodothyronine:

decreased levels

Pregnancy test, protirelin-induced thyroid stimulating hormone, radionuclide thyroid imaging,

serum theophylline (Schack and Waxler method), urine catecholamines, urine glucose, urine
hydroxyindoleacetic acid, urine ketones (ferric chloride method), urine vanillylmandelic acid:
test interference

Tests using phenosulfonphthalein as diagnostic agent: decreased urinary excretion of

phenosulfonphthalein

Urine protein: increased level

Drug-food. Urine-acidifying foods: increased salicylate blood level

Drug-herbs. Anise, arnica, cayenne, chamomile, clove, fenugreek, feverfew, garlic, ginger,
ginkgo biloba, ginseng, horse chestnut, kelpware, licorice: increased bleeding risk

Drug-behaviors. Alcohol use: increased bleeding risk

Patient monitoring

☞ Watch for signs and symptoms of hypersensitivity and other adverse reactions, especially
bleeding tendency.
• Stay alert for signs and symptoms of acute toxicity, such as diplopia, ECG abnormalities,
generalized seizures, hallucinations, hyperthermia, oliguria, acute renal failure, incoherent
speech, irritability, restlessness, tremor, vertigo, confusion, disorientation, mania, lethargy,
laryngeal edema, anaphylaxis, and coma.
• Monitor elderly patients carefully because they're at greater risk for salicylate toxicity.
• With prolonged therapy, frequently assess hemoglobin, hematocrit, International Normalized
Ratio, and kidney function test results.
• Check salicylate blood levels frequently.
• Evaluate patient for signs and symptoms of ototoxicity (hearing loss, tinnitus, ataxia, and
vertigo).

Patient teaching

• Tell patient to report ototoxicity symptoms, unusual bleeding, and bruising.

• Caution patient to avoid activities that may cause injury. Advise him to use soft toothbrush and
electric razor to avoid gum and skin injury.
• Instruct patient to tell all prescribers he's taking the drug, because it may cause serious
interactions with many common medications.
• Tell patient not to take other over-the-counter preparations containing aspirin.
• Inform patient that he may need to undergo regular blood testing during therapy.
• As appropriate, review all other significant and life-threatening adverse reactions and
interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned
above.

Nursing Spectrum Drug Handbook 2009. © 2009 by The McGraw-Hill Companies, Inc.

aspirin

Acetylsalicylate, acetylsalicylic acid Therapeutics A widely used analgesic, antipyretic, antiinflammatory,

and antiplatelet agent; it is one of the safest drugs currently prescribed Adverse effects GI upset, occult
bleeding; high doses inhibit cyclooxygenase and can produce tinnitus, tachycardia, dizziness, deep rapid
breathing, hallucinations, convulsions, coma Used for Pain, fever, rheumatic complaints; acute
rheumatic fever; TIAs, acute MI. See Controlled-release aspirin, NSAID, Superaspirin.
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill
Companies, Inc.

Patient discussion about aspirin.

Q. Is it safe to take aspirin during pregnancy? I have been having headaches and want to take
an aspirin to relieve the pain however I am pregnant. Can I take aspirin whilst pregnant?

A. No, it's not safe. Unless your healthcare provider prescribes it, you should avoid taking aspirin
altogether, as well as other NSAIDs (non-steroidal anti-inflammatory drugs), such as ibuprofen (Advil,
Motrin), naproxen sodium (Aleve), and ketoprofen (Orudis), which can have similar effects.

Check the labels of all over-the-counter drugs to make sure they don't contain aspirin or other NSAIDs.
Better yet, check with your caregiver or pharmacist. It can be hard to tell because some products list
their ingredients under different names. Aspirin is sometimes called salicylate or acetylsalicylic acid, for
example.

When you need to take something for pain relief while you're pregnant, acetaminophen (Tylenol) is
considered safe to use as directed on the label.