Aspirin Cardio tablets solution/intestinal 100 mg No. 56
Directions for use and doses
It is advisable to take ASPIRIN® CARDIO tablets at least 30 minutes before meals with plenty of water.
To ensure the release of ASA in the alkaline environment of the duodenum, the tablets should not be broken, crushed or chewed. ASPIRIN® CARDIO tablets are taken once a day or every other day. ASPIRIN® CARDIO is intended for long-term use. The duration of therapy is determined by the doctor. Primary prevention of acute myocardial infarction in the presence of risk factors: 100 mg/day or 300 mg every other day.
Prevention of recurrent infarction, stable and unstable angina: 100-300 mg/day.
Unstable angina (if the development of acute myocardial infarction is suspected): an initial dose of 100-300 mg (the tablet must be broken, crushed or chewed for faster absorption) should be taken by the patient as soon as possible after the development of acute myocardial infarction is suspected. In the next 30 days after the onset of myocardial infarction, a dose of 200-300 mg/day should be maintained. After 30 days, appropriate therapy should be prescribed to prevent recurrent myocardial infarction.
Prevention of stroke and transient cerebrovascular accident: 100-300 mg/day.
Prevention of thromboembolism after surgery and invasive vascular interventions: 100-300 mg/day.
Prevention of deep vein thrombosis and thromboembolism of the pulmonary artery and its branches: 100-200 mg/day or 300 mg every other day.
What to do if you miss one or more doses of the drug: Take the missed tablet as soon as you remember and then continue taking it as usual. To avoid doubling the dose, do not take the missed tablet if it is near the time of your next tablet.
Peculiarities of the action of the drug upon first administration and upon its discontinuation: No peculiarities of the action of the drug upon first administration and upon its discontinuation were observed.
Special patient groups
- Children
The safety and effectiveness of Aspirin® Cardio in children and adolescents under 18 years of age has not been established. The use of Aspirin® Cardio in patients under 18 years of age is contraindicated.
- Patients with liver dysfunction
Aspirin® Cardio is contraindicated in patients with severe liver dysfunction. Aspirin® Cardio should be used with caution in patients with impaired liver function.
- Patients with impaired renal function
Aspirin® Cardio is contraindicated in patients with severe renal impairment. Aspirin® Cardio should be used with caution in patients with impaired renal function, since taking Aspirin® Cardio may increase the risk of developing renal failure and acute renal failure.
Aspirin® Cardio
When used simultaneously, ASA enhances the effect of the following medications:
- methotrexate by reducing renal clearance and displacing it from protein binding; the use of Aspirin® Cardio together with methotrexate is contraindicated if the dose of the latter exceeds 15 mg per week (see section “Contraindications”) and can be used with caution at a dose of methotrexate less than 15 mg per week;
- heparin and indirect anticoagulants due to disruption of platelet function and displacement of indirect anticoagulants from binding with proteins;
- when used simultaneously with anticoagulants, thrombolytic and antiplatelet agents, there is an increase in the risk of bleeding as a result of the synergism of the main therapeutic effects of the drugs used;
- when used simultaneously with drugs that have anticoagulant, thrombolytic or antiplatelet effects, an increased damaging effect on the mucous membrane of the gastrointestinal tract is observed;
- selective serotonin reuptake inhibitors, which may lead to an increased risk of bleeding from the upper gastrointestinal tract (synergism with ASA);
- digoxin due to a decrease in its renal excretion, which can lead to an overdose;
- hypoglycemic drugs (insulin, sulfonylurea derivatives) due to the hypoglycemic properties of ASA itself in high doses and displacing sulfonylurea derivatives from binding with blood plasma proteins;
- when used simultaneously with valproic acid, its toxicity increases due to displacement from the connection with blood plasma proteins;
- NSAIDs (increased risk of ulcerogenic effect and bleeding from the gastrointestinal tract as a result of synergistic action);
— Ethanol (alcoholic beverages) (increased risk of damage to the mucous membrane of the gastrointestinal tract and prolongation of bleeding time as a result of the mutual enhancement of the effects of ASA and ethanol).
Simultaneous administration of ASA in high doses may weaken the effect of the following drugs:
- any diuretics (when used together with ASA in high doses, a decrease in glomerular filtration rate is observed as a result of a decrease in the synthesis of prostaglandins in the kidneys);
- angiotensin-converting enzyme (ACE) inhibitors (a dose-dependent decrease in glomerular filtration rate (GFR) is noted as a result of inhibition of prostaglandins with a vasodilatory effect, respectively, a weakening of the hypotensive effect;
- drugs with uricosuric action - benzbromarone, probenecid (reduced uricosuric effect due to competitive suppression of renal tubular excretion of uric acid).
When used simultaneously (within one day) with ibuprofen and naproxen, antagonism is observed in relation to irreversible platelet inhibition caused by the action of ASA. The clinical significance of this effect is unknown. The combination of ASA with ibuprofen is not recommended in patients at high risk of cardiovascular disease due to a possible decrease in the cardioprotective effects of ASA. When used simultaneously with systemic glucocorticosteroids (GCS) (with the exception of hydrocortisone or other GCS used for replacement therapy of Addison's disease), there is an increase in the elimination of salicylates and, accordingly, a weakening of their effect. When using GCS and salicylates in combination, it should be remembered that during treatment the level of salicylates in the blood is reduced, and after discontinuation of GCS, an overdose of salicylates is possible.
Buy Aspirin Cardio film-coated tablets 100 mg No. 56 in pharmacies
Aspirin cardio DOSAGE FORMS enteric-coated tablets 100 mg film-coated tablets 100 mg
MANUFACTURERS Bayer AG (Germany) Bayer Bitterfeld GmbH (Germany) Bayer Healthcare AG packaged Bayer Bitterfeld (Germany)
GROUP Anti-inflammatory drugs - salicylic acid derivatives
COMPOSITION The active substance is acetylsalicylic acid.
INTERNATIONAL NON-PROPENTED NAME Acetylsalicylic acid
SYNONYMS Aspicor, Aspirin, Aspirin Express, Aspitrin, Acecardol, Acetylsalicylic acid, Acetylsalicylic acid "York", Acetylsalicylic acid (Aspirin), Acetylsalicylic acid CARDIO, Acetylsalicylic acid MS, Acetylsalicylic acid-Rusfar, Acetylsalicylic acid-UBF, Zorex Morning, CardiASK, Taspir, Thrombo ACC, Thrombogard 100, Thrombopol, Upsarin Upsa
PHARMACOLOGICAL ACTION Pharmacodynamics. The mechanism of the antiplatelet action of acetylsalicylic acid (ASA) is based on the irreversible inhibition of cyclooxygenase (COX-1), as a result of which the synthesis of thromboxane A2 is blocked and platelet aggregation is suppressed. The antiplatelet effect is most pronounced in platelets, because they are unable to re-synthesize cyclooxygenase. It is believed that ASA has other mechanisms of suppressing platelet aggregation, which expands the scope of its use in various vascular diseases. ASA also has anti-inflammatory, analgesic and antipyretic effects. Pharmacokinetics. After oral administration, ASA is quickly and completely absorbed from the gastrointestinal tract. ASA is partially metabolized during absorption. During and after absorption, ASA is converted to its main metabolite, salicylic acid, which is metabolized primarily in the liver under the influence of enzymes to form metabolites such as phenyl salicylate, glucuronide salicylate and salicyluric acid, found in many tissues and in the urine. In women, the metabolic process is slower (less enzyme activity in the blood serum). The maximum concentration of ASA in the blood plasma is achieved 10-20 minutes after oral administration, salicylic acid - after 0.3-2 hours. Due to the fact that the tablets are coated with an acid-resistant coating, ASA is not released in the stomach (the coating effectively blocks the dissolution of the drug in the stomach) , and in the alkaline environment of the duodenum. Thus, the absorption of ASA in the form of enteric-coated tablets is delayed by 3-6 hours compared to conventional (without such a coating) tablets. ASA and salicylic acid bind to plasma proteins (from 66% to 98% depending on the dose) and are quickly distributed in the body. Salicylic acid crosses the placental barrier and is excreted in breast milk. The elimination of salicylic acid is dose-dependent, since its metabolism is limited by the capabilities of the enzymatic system. The half-life ranges from 2-3 hours when using ASA in low doses and up to 15 hours when using the drug in high doses (usual doses of acetylsalicylic acid as an analgesic). Unlike other salicylates, with repeated administration of the drug, non-hydrolyzed ASA does not accumulate in the blood serum. Salicylic acid and its metabolites are excreted by the kidneys. In patients with normal renal function, 80-100% of a single dose of the drug is excreted by the kidneys within 24-72 hours.
INDICATIONS FOR USE Primary prevention of acute myocardial infarction in the presence of risk factors (for example, diabetes mellitus, hyperlipidemia, arterial hypertension, obesity, smoking, old age) and recurrent myocardial infarction; unstable angina (including suspicion of acute myocardial infarction) and stable angina; prevention of stroke (including in patients with transient cerebrovascular accident); prevention of transient cerebrovascular accident; prevention of thromboembolism after operations and invasive vascular interventions (for example, coronary artery bypass surgery, carotid endarterectomy, arteriovenous bypass, angioplasty and stenting of the coronary arteries, carotid angioplasty); prevention of deep vein thrombosis and thromboembolism of the pulmonary artery and its branches (including with prolonged immobilization as a result of extensive surgery).
CONTRAINDICATIONS Hypersensitivity to acetylsalicylic acid, excipients in the drug and other NSAIDs; bronchial asthma induced by taking salicylates and other NSAIDs; a combination of bronchial asthma, recurrent polyposis of the nose and paranasal sinuses and intolerance to ASA; erosive and ulcerative lesions of the gastrointestinal tract in the acute stage; gastrointestinal bleeding; hemorrhagic diathesis; combined use with methotrexate at a dose of 15 mg per week or more; pregnancy (I and III trimesters); lactation period; childhood and adolescence (up to 18 years); severe renal failure (creatinine clearance less than 30 ml/min); severe liver failure (class B and higher on the Child-Pugh scale); chronic heart failure of functional class III-IV according to the NYHA classification.
SIDE EFFECTS From the digestive system: the most common symptoms are nausea, heartburn, vomiting, abdominal pain; rarely - ulcers of the mucous membrane of the stomach and duodenum; very rarely - perforated ulcers of the mucous membrane of the stomach and duodenum, gastrointestinal bleeding (with corresponding clinical symptoms and laboratory changes), transient liver dysfunction with increased activity of liver transaminases. From the hematopoietic system: the administration of ASA is accompanied by an increased risk of bleeding due to the inhibitory effect of ASA on platelet aggregation. An increase in the frequency of perioperative (intra- and postoperative) bleeding, hematomas, nosebleeds, bleeding gums, and bleeding from the genitourinary tract was registered. There have been reports of serious cases of bleeding, which include gastrointestinal bleeding and cerebral hemorrhage (especially in patients with arterial hypertension who have not achieved blood pressure targets and/or receiving concomitant therapy with anticoagulant drugs), which in some cases can be life-threatening. . Bleeding can lead to the development of acute or chronic posthemorrhagic/iron deficiency anemia (for example, due to hidden bleeding) with corresponding clinical and laboratory signs and symptoms (asthenia, pallor, hypoperfusion). There are reports of cases of hemolysis and hemolytic anemia in patients with severe forms of glucose-6-phosphate dehydrogenase deficiency. Allergic reactions: hypersensitivity reactions with corresponding laboratory and clinical manifestations, such as asthmatic syndrome (bronchospasm), mild to moderate reactions of the skin, respiratory tract, gastrointestinal tract and cardiovascular system, including symptoms such as skin rash, itching , urticaria, Quincke's edema, rhinitis, swelling of the nasal mucosa, rhinitis, cardiorespiratory distress syndrome, as well as severe reactions, including anaphylactic shock. From the central nervous system: there are reports of cases of dizziness, hearing loss, headache, tinnitus, which may be a sign of a drug overdose. From the urinary system: there are reports of cases of renal dysfunction and acute renal failure.
INTERACTION When used simultaneously, ASA enhances the effect of the following drugs; if it is necessary to simultaneously prescribe ASA with the listed drugs, you should consider the need to reduce the dose of these drugs: methotrexate by reducing renal clearance and displacing it from protein binding; the combination of ASA with methotrexate is accompanied by an increased incidence of side effects from the hematopoietic organs; the use of the drug together with methotrexate is contraindicated if the dose of the latter exceeds 15 mg per week and, possibly, with caution - with a dose of methotrexate less than 15 mg per week; heparin and indirect anticoagulants due to disruption of platelet function and displacement of indirect anticoagulants from binding with proteins; when used simultaneously with anticoagulants, thrombolytic and antiplatelet agents (ticlopidine), there is an increase in the risk of bleeding as a result of the synergism of the main therapeutic effects of the drugs used; when used simultaneously with drugs that have anticoagulant, thrombolytic or antiplatelet effects, an increased damaging effect on the mucous membrane of the gastrointestinal tract is observed; selective serotonin reuptake inhibitors, which may lead to an increased risk of bleeding from the upper gastrointestinal tract (synergism with ASA); digoxin due to a decrease in its renal excretion, which can lead to an overdose; hypoglycemic agents for oral administration (sulfonylurea derivatives) and insulin due to the hypoglycemic properties of ASA itself in high doses and displacing sulfonylurea derivatives from association with blood plasma proteins; this must be kept in mind when prescribing ASA to patients with diabetes mellitus receiving the listed medications; when used simultaneously with valproic acid, its toxicity increases due to displacement from the connection with blood plasma proteins; NSAIDs and salicylic acid derivatives in high doses (increased risk of ulcerogenic effect and bleeding from the gastrointestinal tract as a result of synergistic action); ethanol (alcoholic beverages) (increased risk of damage to the gastrointestinal mucosa and prolongation of bleeding time as a result of the mutual enhancement of the effects of ASA and ethanol). Simultaneous administration of ASA in high doses may weaken the effect of the following drugs (if simultaneous administration of ASA with the listed drugs is necessary, the need to adjust the dose of the drugs listed below should be considered): any diuretics (when combined with ASA in high doses, a decrease in glomerular filtration rate is observed as a result of decreased synthesis of prostaglandins in the kidneys); ACE inhibitors (a dose-dependent decrease in glomerular filtration rate (GFR) is noted as a result of inhibition of prostaglandins that have a vasodilatory effect, correspondingly a weakening of the hypotensive effect. Clinical significance of the decrease in GFR is observed with a daily dose of ASA more than 160 mg. In addition, there is a decrease in the positive cardioprotective effect of ACE inhibitors, prescribed to patients for the treatment of chronic heart failure. This effect is also manifested when used in conjunction with ASA in large doses); drugs with uricosuric action - benzbromarone, probenecid (reduced uricosuric effect due to competitive suppression of renal tubular excretion of uric acid). When used simultaneously with ibuprofen, antagonism is observed against the irreversible platelet inhibition caused by the action of ASA, which leads to a decrease in the cardioprotective effects of ASA. Therefore, the combination of ASA with ibuprofen is not recommended in patients with an increased risk of cardiovascular disease. When used simultaneously with systemic corticosteroids (with the exception of hydrocortisone or other corticosteroids used for replacement therapy of Addison's disease), there is an increase in the elimination of salicylates and, accordingly, a weakening of their effect. When using GCS and salicylates in combination, it should be remembered that during treatment the level of salicylates in the blood is reduced, and after discontinuation of GCS, an overdose of salicylates is possible.
METHOD OF APPLICATION AND DOSAGE It is advisable to take the tablets before meals with plenty of liquid. Tablets are taken once a day. The drug is intended for long-term use. The duration of therapy is determined by the doctor. Primary prevention of acute myocardial infarction in the presence of risk factors: 100 mg per day. Prevention of recurrent infarction, stable and unstable angina: 100-300 mg per day. Unstable angina (if the development of acute myocardial infarction is suspected): an initial dose of 100-300 mg (the first tablet must be chewed for faster absorption) should be taken by the patient as soon as possible after the development of acute myocardial infarction is suspected. In the next 30 days after the development of myocardial infarction, a dose of 200-300 mg per day should be maintained. After 30 days, appropriate therapy should be prescribed to prevent recurrent myocardial infarction. Prevention of stroke and transient cerebrovascular accident: 100-300 mg per day. Prevention of thromboembolism after operations and invasive interventions on blood vessels: 100-300 mg per day. Prevention of deep vein thrombosis and thromboembolism of the pulmonary artery and its branches: 100-200 mg per day. If you miss one or more doses of the drug, the patient should take the missed tablet as soon as he remembers and then continue taking it as usual. To avoid doubling the dose, do not take the missed tablet if it is near the time of taking the next tablet. Features of the action of the drug when first taken and when discontinued. No specific effects of the drug were observed during the first dose or its withdrawal.
OVERDOSE Salicylate intoxication (develops when taking ASA at a dose of more than 100 mg/kg/day for more than 2 days) can result from prolonged use of toxic doses of the drug as part of improper therapeutic use of the drug (chronic intoxication) or a single accidental or intentional intake of a toxic dose drug for an adult or child (acute intoxication). Symptoms of chronic intoxication with salicylic acid derivatives are nonspecific and are often difficult to diagnose. Mild intoxication usually develops only after repeated use of large doses of the drug and is manifested by dizziness, tinnitus, hearing loss, increased sweating, nausea and vomiting, headache and confusion. These symptoms disappear after reducing the dose of the drug. Tinnitus may appear when the concentration of ASA in the blood plasma is from 150 to 300 mcg/ml. More severe symptoms appear when plasma ASA concentrations are above 300 mcg/ml. The main manifestation of acute intoxication is a severe disturbance of the acid-base state, the manifestations of which may vary depending on the age of the patient and the severity of intoxication. In children, the most typical development is metabolic acidosis. Treatment of intoxication is carried out in accordance with accepted standards and depends on the severity of intoxication and the clinical picture and should be aimed mainly at accelerating the elimination of the drug and restoring the water-electrolyte balance and acid-base state. Symptoms of overdose are mild to moderate: dizziness, tinnitus, hearing loss, increased sweating, nausea, vomiting, headache, confusion, profuse sweating, tachypnea, hyperventilation, respiratory alkalosis. Treatment: gastric lavage, repeated intake of activated carbon, forced alkaline diuresis, restoration of water-electrolyte balance and acid-base state. Symptoms of moderate to severe overdose: respiratory alkalosis with compensatory metabolic acidosis, hyperpyrexia (extremely high body temperature); respiratory disorders (hyperventilation, non-cardiogenic pulmonary edema, respiratory depression, asphyxia); disorders of the cardiovascular system (heart rhythm disturbances, arterial hypotension, cardiac depression); disturbances of water and electrolyte balance (dehydration, impaired renal function from oliguria up to the development of renal failure, characterized by hypokalemia, hypernatremia, hyponatremia); impaired glucose metabolism (hyperglycemia, hypoglycemia /especially in children/, ketoacidosis); tinnitus, deafness; gastrointestinal bleeding; hematological disorders (from inhibition of platelet aggregation to coagulopathy, prolongation of prothrombin time, hypoprothrombinemia); neurological disorders (toxic encephalopathy and depression of central nervous system function/drowsiness, confusion, coma, convulsions). Treatment: immediate hospitalization in specialized departments for emergency treatment - gastric lavage, repeated intake of activated charcoal, forced alkaline diuresis, hemodialysis, restoration of water-electrolyte balance and acid-base status, symptomatic therapy.
SPECIAL INSTRUCTIONS With caution: for gout, hyperuricemia, because ASA in low doses reduces the excretion of uric acid; It should be borne in mind that ASA in low doses can provoke the development of gout in predisposed patients (those with reduced excretion of uric acid); if there is a history of ulcerative lesions of the gastrointestinal tract or gastrointestinal bleeding; with impaired liver function (below class B on the Child-Pugh scale); with impaired renal function (creatinine clearance more than 30 ml/min), as well as with circulatory disorders resulting from atherosclerosis of the renal arteries, congestive heart failure, hypovolemia, extensive surgery, sepsis, cases of massive bleeding, since in all of these cases ASA can increase the risk development of acute renal failure and renal dysfunction; for bronchial asthma, chronic respiratory diseases, hay fever, nasal polyposis, drug allergies, incl. NSAIDs (analgesics, anti-inflammatory, antirheumatic drugs); in the second trimester of pregnancy; during the proposed surgical intervention (including minor ones, for example, tooth extraction), because ASA may cause a tendency to develop bleeding for several days after taking the drug; when used in combination with the following drugs: with methotrexate at a dose of less than 15 mg per week; with anticoagulant, thrombolytic or antiplatelet agents; with NSAIDs and salicylic acid derivatives in large doses; with digoxin; with hypoglycemic agents for oral administration (sulfonylurea derivatives) and insulin; with valproic acid; with alcohol (including alcoholic drinks); with selective serotonin reuptake inhibitors; with ibuprofen. The drug should be used as prescribed by a doctor. ASA can provoke bronchospasm, as well as cause attacks of bronchial asthma and other hypersensitivity reactions. Risk factors include a history of bronchial asthma, hay fever, nasal polyposis, chronic respiratory diseases, and allergic reactions to other drugs (for example, skin reactions, itching, urticaria). The inhibitory effect of ASA on platelet aggregation persists for several days after administration, and therefore may increase the risk of bleeding during surgery or in the postoperative period. If it is necessary to absolutely exclude bleeding during surgery, it is necessary, if possible, to completely abandon the use of ASA in the preoperative period. Exceeding the dose of ASA is associated with a risk of gastrointestinal bleeding. Overdose is especially dangerous in elderly patients. In severe forms of glucose-6-phosphate dehydrogenase deficiency, ASA can cause hemolysis and hemolytic anemia. Factors that may increase the risk of hemolysis include fever, acute infections and high doses of the drug.
STORAGE CONDITIONS Store out of the reach of children at a temperature not exceeding 25 C.
