Home Drug IndexClinical Monograph

Aspirin Uses, Dosage, Side Effects & Benefits | DrugsAtlas

Authoritative Clinical Reference

Therapeutic Class

Antiplatelet agent / Analgesic / Antipyretic

Subclass

Non-steroidal anti-inflammatory drug (NSAID), Salicylate

Speciality

Cardiology

Schedule (India)

Schedule H

Routes

Oral, Rectal, Intravenous (NOT AVAILABLE in India)

Formulations

75 mg, 81 mg, 100 mg, 150 mg, 300 mg tablets (enteric-coated or plain)
325 mg, 500 mg tablets (analgesic/antipyretic use)
75 mg, 150 mg dispersible/chewable tablets (specialist use)
350 mg, 500 mg rectal suppository (limited availability)
NOT AVAILABLE in India: IV formulation

Adult indications

Primary Indications (Approved / Standard in India)

1. Secondary Prevention of Cardiovascular and Cerebrovascular Events

(Post-MI, Post-stroke, TIA, Peripheral Arterial Disease)

Parameter	Dose
Starting dose	75–150 mg once daily
Titration	Not applicable
Usual maintenance dose	75–150 mg once daily
Maximum dose	150 mg once daily

Clinical Notes:

Enteric-coated formulation preferred for long-term use
Combine with clopidogrel for first 12 months post-ACS or post-PCI
Indefinite therapy unless contraindicated

2. Acute Coronary Syndrome (STEMI / NSTEMI / Unstable Angina)

Phase	Dose	Notes
Loading dose	150–325 mg stat	Chew non-enteric coated tablet for rapid absorption
Titration	Not applicable	—
Maintenance dose	75–150 mg once daily	Start from Day 1
Maximum dose	325 mg (loading); 150 mg (maintenance)	—

Clinical Notes:

Co-administer with P2Y12 inhibitor (clopidogrel/ticagrelor/prasugrel) as per DAPT protocol
Continue anticoagulation per institutional ACS pathway
Do NOT use enteric-coated tablets for loading (delayed absorption)

3. Analgesic / Antipyretic (Short-term Use Only)

Parameter	Dose
Starting dose	325–500 mg every 4–6 hours as needed
Titration	Not applicable
Usual maintenance dose	325–500 mg every 4–6 hours
Maximum dose	4 g/day

Clinical Notes:

Use limited to short-term only due to GI and bleeding risks
Paracetamol preferred in most analgesic/antipyretic settings
Avoid in patients with peptic ulcer history or concurrent anticoagulation

Secondary Indications – Adults (Off-label)

Indication	Dose	Duration	Supervision	Evidence Basis
Prevention of Pre-eclampsia (OFF-LABEL)	75–150 mg once daily at bedtime	12–16 weeks gestation until 36 weeks	Specialist only (Obstetrician)	FOGSI consensus; ICMR high-risk pregnancy guidance
Colorectal Cancer Chemoprevention (OFF-LABEL)	75–100 mg once daily	Long-term (years)	Specialist only (Oncologist/Gastroenterologist)	International RCTs (CAPP2, ASPREE); not standard Indian public health practice

Paediatric indications

PAEDIATRIC DOSING (Specialist Only)

Not recommended in children <16 years except for specific indications below due to risk of Reye's syndrome.

Primary Indication: Kawasaki Disease

Minimum Age: ≥6 months

Phase	Dose	Duration	Monitoring
Acute phase (High-dose)	30–50 mg/kg/day in 4 divided doses	Until 2–3 days after fever resolution	Platelet count, LFTs, bleeding signs
Titration	Step down to low-dose once afebrile	—	—
Maintenance (Low-dose)	3–5 mg/kg once daily	6–8 weeks minimum; longer if coronary abnormalities persist	Echocardiography, platelet count
Maximum dose	4 g/day (acute phase)	—	—

Clinical Notes:

Always use with IVIG in acute Kawasaki disease
Continue low-dose aspirin until coronary arteries normalise on imaging
Follow IAP Kawasaki Management Guidelines

Secondary Indications – Paediatrics (Off-label)

Indication	Dose	Duration	Supervision	Evidence Basis
Antiplatelet therapy post cardiac surgery / congenital heart disease (OFF-LABEL)	1–5 mg/kg once daily	As directed by cardiologist	Specialist only (Paediatric Cardiologist)	Indian paediatric cardiology practice; limited RCT data

Renal Adjustments

eGFR (mL/min/1.73 m²)	Recommendation
>60	No adjustment required
30–60	Use with caution; monitor renal function regularly
<30	Avoid — increased bleeding and nephrotoxicity risk
Haemodialysis	Avoid chronic use; not effectively dialysed

Hepatic adjustment

Contraindications

Hypersensitivity to aspirin, salicylates, or any excipients
Active peptic ulcer disease or gastrointestinal bleeding
Haemorrhagic disorders (haemophilia, severe thrombocytopenia)
Severe hepatic impairment
Severe renal impairment (eGFR <30)
Third trimester of pregnancy
Children/adolescents with viral illness (varicella, influenza) — Reye's syndrome risk
History of aspirin-induced asthma, urticaria, or angioedema

Cautions

Asthma or history of bronchospasm (aspirin-exacerbated respiratory disease)
Concurrent anticoagulant or antiplatelet therapy
History of peptic ulcer disease (healed)
G6PD deficiency (risk of haemolysis at high doses)
Chronic kidney disease (dose-dependent worsening)
Uncontrolled hypertension
Perioperative period — discontinue 5–7 days prior to surgery if bleeding risk unacceptable
Gout (low-dose aspirin may increase uric acid levels)

Pregnancy

Trimester	Safety	Notes
1st	Use only if essential; avoid high doses	Theoretical risk of fetal loss; limited data
2nd	May be used with caution at low doses	Consider for high-risk pre-eclampsia prophylaxis under specialist guidance
3rd	Avoid	Risk of premature ductus arteriosus closure, oligohydramnios, maternal/fetal bleeding; stop by 36 weeks

Preferred Alternative for Analgesia: Paracetamol

Monitoring: Bleeding parameters, amniotic fluid volume (if continued beyond 28 weeks)

Lactation

Parameter	Information
Compatibility	Compatible at low doses (≤150 mg/day)
Preferred Alternative	Paracetamol (for analgesia)
Expected Drug Level in Milk	Low
Infant Monitoring	Bruising, feeding difficulties, GI symptoms (rare)

Elderly

Parameter	Recommendation
Starting dose	Same as adult; use lower end of range
Titration	Slower titration for analgesic use
Increased Risks	GI bleeding, renal impairment, tinnitus, falls (via drug interactions)
Additional Measures	Co-prescribe PPI for long-term CV prevention use

Major drug interactions

Interacting Drug	Effect	Management
Warfarin	↑↑ Bleeding risk	Avoid unless compelling indication; close INR and bleeding monitoring
DOACs (apixaban, rivaroxaban, dabigatran)	↑↑ Bleeding risk	Avoid unless cardiologist-directed; monitor for bleeding
Ibuprofen and other NSAIDs	May antagonise antiplatelet effect of aspirin	Avoid; if essential, give aspirin 30 min before ibuprofen
Methotrexate (high-dose)	↓ MTX clearance → ↑ toxicity	Avoid concurrent use with high-dose MTX; monitor closely with low-dose MTX
SSRIs (sertraline, fluoxetine)	↑ GI bleeding risk	Consider PPI cover; monitor for bleeding
Probenecid / Sulfinpyrazone	Aspirin antagonises uricosuric effect	Avoid combination in gout management

Moderate drug interactions

Interacting Drug	Effect	Management
ACE inhibitors / ARBs	Reduced antihypertensive effect	Monitor blood pressure
Diuretics (loop, thiazide)	Reduced diuretic efficacy; ↑ nephrotoxicity	Monitor renal function and fluid status
Sulfonylureas	Hypoglycaemia (protein binding displacement)	Monitor blood glucose; rare clinical significance
Corticosteroids	Additive gastric toxicity	Use PPI cover if concurrent use required
Valproic acid	↑ Valproate levels (protein binding displacement)	Monitor valproate levels
Alcohol	↑ GI bleeding risk	Counsel patient to limit alcohol

Common Adverse effects

Dyspepsia, epigastric discomfort
Nausea, heartburn
Easy bruising
Minor bleeding (gingival, epistaxis)
Tinnitus (dose-related; may indicate toxicity

Serious Adverse effects

Adverse Effect	Clinical Action
GI haemorrhage / peptic ulceration	Discontinue; may require hospitalisation, endoscopy, blood transfusion
Intracranial haemorrhage	Discontinue immediately; neurosurgical evaluation
Reye's syndrome (children)	Contraindicated in viral illness; supportive care if occurs
Anaphylaxis / Aspirin-induced asthma	Discontinue permanently; emergency management
Stevens-Johnson Syndrome / TEN	Rare; discontinue permanently
Severe bronchospasm	Discontinue; bronchodilator therapy

Monitoring requirements

Timing	Parameters
Baseline	CBC, renal function (creatinine, eGFR), liver enzymes, bleeding history assessment
During therapy (long-term)	CBC periodically, faecal occult blood (if GI symptoms), serum creatinine
Acute CV use	Bleeding assessment, blood pressure, symptom control
Paediatric (Kawasaki)	Platelet count, LFTs, echocardiography, fever curve
Signs of toxicity	Tinnitus, hearing changes, hyperventilation (salicylism)

Brands in India

Ecosprin™ (USV) — 75 mg, 150 mg, 325 mg
Loprin™ (Shreya Life Sciences) — 75 mg, 150 mg
Cardispan™ — enteric-coated low-dose
Aspisol™ — analgesic dose tablets
Disprin™ (Reckitt) — dispersible 350 mg
Colsprin™ — 100 mg
Fixed-Dose Combinations: Ecosprin-AV (with atorvastatin), Ecosprin Gold (with clopidogrel + atorvastatin), Clopitab-A (with clopidogrel)

Price range (INR)

Formulation	Price Range	Notes
75 mg tablet	₹0.30–₹1.00 per tablet	Generic/branded
150 mg tablet	₹0.50–₹1.50 per tablet	—
325 mg tablet	₹0.80–₹2.00 per tablet	—
500 mg tablet	₹1.00–₹2.50 per tablet	—

Regulatory: Listed under NLEM 2022; select strengths under NPPA price control

Clinical pearls

Acute ACS: Always use non-enteric coated, chewable aspirin for loading — enteric coating delays absorption by 3–4 hours
Long-term CV prevention: Use enteric-coated formulations to reduce gastric irritation
NSAID interaction: Ibuprofen given before aspirin blocks the antiplatelet binding site — give aspirin at least 30 minutes before ibuprofen if both required
Elderly patients: Co-prescribe PPI (pantoprazole/omeprazole) routinely for GI protection in long-term therapy
Paediatrics: Never prescribe to children <16 years with fever/viral illness — always rule out viral aetiology before considering aspirin
Bleeding counselling: Educate patients to report black stools, blood in vomit, unusual bruising, or prolonged bleeding from cuts

Version

RxIndia v1.1 — 01 May 2025

⚖️

Clinical Responsibility

This platform is designed strictly for healthcare professionals. Data provided is synthesized from authoritative pharmacological sources and clinical registries. Do not use for consumer medical decisions. Always verify critical dosing and contraindications with official institutional protocols and peer-reviewed journals.

Content Feedback

Is this information helpful?

Help us improve our clinical database for the medical community.

RxIndia

Loading clinical data...