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Instructions / Instruction for use: Acetylsalicylic acid (Acidum acetylsalicylicum)

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Pharmacological groups

Antiaggregants

NSAIDs - Salicylic acid derivatives

Nosological classification (ICD-10)

G43 Migraine

The pain of migraine, Migraine, hemiplegic migraine, Migraine headache, A migraine attack, Continuous headache, hemicrania

G54.3 Lesions of thoracic roots, not elsewhere classified

Thoracic radicular syndrome

I20.0 Unstable angina

Unstable angina, heberden disease

I21.9 Acute myocardial infarction, unspecified

Changes in the left ventricle with myocardial infarction, Changes in the left atrium with myocardial infarction, Myocardial infarction, Myocardial infarction without Q wave, Myocardial infarction without signs of chronic heart failure, Myocardial infarction with unstable angina, Pirouette tachycardia with myocardial infarction

I24.1 Dressler Syndrome

Postpericardiotomy syndrome, Postinfarction syndrome (Dressler's syndrome)

I25 Chronic ischemic heart disease

Coronary heart disease on the background of hypercholesterolemia, Coronary heart disease is a chronic, Coronary heart disease, Stable coronary artery disease, Percutaneous transluminal angioplasty, Myocardial ischemia, arteriosclerosis, Recurrent myocardial ischemia

I25.5 Ischemic cardiomyopathy

Metabolic disorders in the myocardium, Ischemic cardiopathy

I25.8 Other forms of chronic ischemic heart disease

I26.9 Pulmonary embolism without mention of an acute pulmonary heart

Lung infarction

I34.0 Mitral (valve) failure

Rupture of papillary muscles, Valvular mitral heart disease, Lack of left atrioventricular valve, Mitral valve insufficiency, Tightening valve (dangling) syndrome

I34.1 prolapse [prolapse] mitral valve

Rupture of papillary muscle, Barlow syndrome, Mitral valve prolapse syndrome, Mitral valve prolapse

I49.8 Other specified cardiac arrhythmias

atrial fibrillation, Arrhythmia Paroxysmal atrial, Atrial arrhythmia tachysystolic, sinus arrhythmia, Asynergia ventricular, Asynergia left ventricle, Corrigan's pulse, atrial fibrillation, atrial tachyarrhythmia, The migration of supraventricular pacemaker, Orthostatic changes in pulse, Disclaimer sinoatrial node, The paradoxical pulse, Paroxysm of atrial fibrillation, Paroxysmal atrial fibrillation, Paroxysmal dysrhythmia, Paroxysmal atrial-ventricular rhythm, Romano-Ward syndrome, trigemini, bigeminy

I63 Cerebral infarction

Stroke ischemic, Ischemic disease of the brain, Ischemic stroke, Ischemic stroke and its consequences, Ischemic cerebral stroke, Ischemic impairment of cerebral circulation, Ischemic damage of the brain, Ischemic brain damage, Ischemic state, Ischemia of the brain, Acute hypoxia of the brain, Acute cerebral ischemia, Acute ischemic impairment of cerebral circulation, Acute cerebral infarction, Acute ischemic stroke, Acute period of ischemic stroke, Focal cerebral ischemia, Postponed ischemic stroke, Repeated stroke, Morgagni-Adams-Stokes Syndrome, Chronic cerebral ischemia, Cerebrovascular stroke, Embolic Stroke, Ischemic brain damage

I74.9 Embolism and thrombosis of unspecified arteries

Arterial embolism, Arterial thrombosis, Acute arterial thromboembolism, Acute Vascular Occlusion, Acute occlusion of arteries, Acute arterial thrombosis, Acute thrombosis, Acute thrombosis of peripheral arteries, Thrombosis, Thrombosis in the extracorporeal circulation, Thrombosis of peripheral arteries, Peripheral vascular thrombosis, Shunttromboz, Embolism, Embolism of peripheral arteries, Occlusive Artery Disease

I77.6 Arteritis, unspecified

Aortoarteritis, Vasculitis, Non-atherosclerotic lesion of the coronary arteries

I80 Phlebitis and thrombophlebitis

Diseases of peripheral vessels, Inflammation of superficial veins, Inflammatory diseases of veins, Deep venous thrombophlebitis, The disease of veins, Disease of the veins of the lower extremities, Diseases of peripheral vessels, Migrating phlebitis, Insufficiency of veins of lower extremities, Exacerbation of chronic thrombophlebitis, Acute thrombophlebitis,Acute thrombophlebitis of superficial veins, Periphlebitis, Periflebit surface, Superficial inflammation of veins, Surface thrombophlebitis, Surface phlebitis, Thrombophlebitis, Deep vein thrombophlebitis, Thrombophlebitis superficial, Phlebitis, Phlebitis of deep veins, Phlebitis of superficial veins, Phlebopathy, Chronic thrombophlebitis, Endophlebitis

K08.8.0 * Painful toothache

Dentinal pain, Dentinal pains, Pain pulpitis, Anesthesia in dentistry, Pain syndromes in dental practice, Pain after removal of tartar, Pain when extracting a tooth, Toothache, Pain after dental interventions

M25.5 Pain in the joint

Arthralgia, Pain syndrome in musculo-articular diseases, Pain syndrome in osteoarthritis, Pain syndrome in osteoarthritis, Pain syndrome in acute inflammatory diseases of the musculoskeletal system, Pain syndrome in chronic inflammatory diseases of the musculoskeletal system, Pain in the joints, Soreness of the joints, Soreness of joints in severe physical exertion, Painful inflammatory joint damage, Painful conditions of the musculoskeletal system, Painful joint conditions, Painful traumatic affection of joints, Pain in the musculoskeletal system, Pain in Shoulder Joints, Pain in the joints, Joint pain, Joint pain with injuries, Musculoskeletal pain, Pain with osteoarthritis, Pain in the pathology of the joints, Pain in rheumatoid arthritis, Pain in chronic degenerative bone diseases, Pain in chronic degenerative joint diseases, Bone-joint pain, Joint pain, Arthritic pain of rheumatic origin, Articular pain syndrome, Joint pain, Rheumatic pain, Rheumatic pains

M54.4 Lumbago with sciatica

Pain in the lumbosacral spine, Lumbago, Sciatica, Lumbar syndrome

M79.1 Myalgia

Myofascial pain syndromes ,Pain syndrome in musculo-articular diseases, Pain syndrome in chronic inflammatory diseases of the musculoskeletal system, Pain in the muscles, Tenderness of muscles, Muscular soreness in severe physical exertion, Painful conditions of the musculoskeletal system, Pain in the musculoskeletal system, Pain in the muscles, Pain at rest, Muscle aches, Muscle pain, Musculoskeletal pain, Myalgia, Muscle pain, Muscle pain at rest, Muscle pain, Muscular pain of non-rheumatic origin, Muscle pain of rheumatic origin, Acute muscle pain, Rheumatic pain, Rheumatic pains, Myofascial syndrome, Fibromyalgia

M79.2 Neurology and neuritis, unspecified

Pain syndrome with neuralgia, Brachialgia, Occipital and intercostal neuralgia, Neuralgia, Neuralgic pain, Neuralgia, Neuralgia of intercostal nerves,Neuralgia of the posterior tibial nerve, Neuritis, Neuritis traumatic, Neuritis, Neurological Pain Syndromes, Neurological contractures with spasms, Acute neuritis, Peripheral neuritis,Post-traumatic neuralgia,Severe pain of a neurogenic nature, Chronic neuritis, Essential neuralgia

N94.6 Dysmenorrhea Unspecified

Pain during menstruation, Functional disorders of the menstrual cycle, Menstrual cramps, Emmeniopathy, Pain during menstruation, Painful menstrual irregularities, algomenorrhea, algomenoreya, Pain smooth muscle spasm, Pain spasm of smooth muscles (renal and biliary colic, intestinal spasms, dysmenorrhea), Pain spasm of smooth muscles of internal organs (kidney and biliary colic, intestinal spasms, dysmenorrhea), Disalgomenoreya, dysmenorrhea, Dysmenorrhea (essential) (Exfoliative), menstrual disorder, menstruation painful, metrorrhagia, Violation of the menstrual cycle, Menstrual irregularities, Prolaktinzavisimoe menstrual disorders, Prolaktinzavisimoe menstrual dysfunction, Pain spasm of smooth muscles of internal organs, Spasmodic dysmenorrhea, Primary disalgomenoreya

R50 Fever of unknown origin

Malignant hyperthermia, Hyperthermia malignant

R51 Headache

Pain in the head, Cephalgia, Pain with sinusitis, Pain in the back of the head, Painful headache, Headache of vasomotor genesis, Headache of vasomotor origin, Headache with vasomotor disorders, Headache, Neurological headache, Serial headache

Z100 * CLASS XXII Surgical practice

Abdominal surgery, adenomectomy, Amputation, Coronary angioplasty, Angioplasty of the carotid arteries, Antiseptic skin treatment for wounds, Antiseptic Hand, Appendectomy, atherectomy, Balloon coronary angioplasty, Vaginal hysterectomy, The coronary bypass, Interventions in the vagina and cervix, Interventions on the bladder, Intervention in the mouth, Restoration and reconstructive surgery, Hand hygiene of medical personnel, Gynecologic surgery, Gynecological intervention, Gynecological surgery, Hypovolemic shock during operations, Disinfection of purulent wounds, Disinfection of wounds edges, Diagnostic intervention, Diagnostic procedures, Cervical Diathermocoagulation, Long-surgery, Replacing the fistula catheters, Infection in orthopedic surgery, Artificial heart valve, cystectomy, Short-term outpatient surgery, Short-term operation, Short surgical procedures, Krikotireotomiya, Blood loss during surgery, Bleeding during surgery and in the postoperative period, Kuldotsentez, laser photocoagulation, laser coagulation, retinal laser coagulation, Laparoscopy, Laparoscopy in Gynecology, CSF fistula, Small gynecological operations, Small surgical procedures, Mastectomy and subsequent plastic, mediastinotomy, Microsurgical operations on the ear, Mukogingivalnye operation, suturing, Minor surgery, neurosurgical operation, Immobilization of the eyeball in ophthalmic surgery, testectomy, pancreatectomy, Perikardektomiya, The period of rehabilitation after surgery, The period of, convalescence after surgery, Percutaneous transluminal coronary angioplasty, Pleural thoracentesis, Pneumonia postoperative and posttraumatic, Preparation for surgical procedures, Preparation for surgery, Preparation of the surgeon's hands before surgery, Preparation of the colon for surgical procedures, Postoperative aspiration pneumonia in neurosurgical and thoracic surgery, Postoperative nausea, Postoperative bleeding, postoperative granuloma, postoperative shock, The early postoperative period, myocardial revascularization, Radiectomy, gastric Resection, bowel resection, uterine Resection, liver Resection, enterectomy, Resection of part of the stomach, Reocclusion of the operated vessel, Bonding tissues during surgical procedures, Removal of sutures, Condition after eye surgery, Condition after surgery, Condition after surgery in the nasal cavity, Condition after gastrectomy, Status after resection of the small intestine, Condition after tonsillectomy, Condition after removal of the duodenum, Condition after phlebectomy, Vascular surgery, Splenectomy, Sterilization of surgical instruments, Sterilization of surgical instruments, sternotomy, Dental surgery, Dental intervention in periodontal tissues, strumectomy, Tonsillectomy, Thoracic surgery, total gastrectomy, Transdermal intravascular coronary angioplasty, Transurethral resection, Turbinektomiya, Removal of a tooth, cataract surgery, Removal of cysts, tonsillectomy, Removal of fibroids, Removing the mobile primary teeth, Removing polyps, Removing broken tooth, Removal of the uterus body, Removal of sutures, Urethrotomy, Fistula likvoroprovodyaschih ways, Frontoetmoidogaymorotomiya, Surgical infection, Surgical treatment of chronic limb ulcersm, Surgery, The surgery in the anal area, The surgery on the colon, Surgical practice, The surgical procedure, Surgical interventions, Surgery on the gastrointestinal tract, Surgical procedures on the urinary tract, Surgical procedures on the urinary system, Surgical intervention of the genitourinary system, Surgical procedures on the heart, Surgical manipulation, surgery, Surgery on the veins, Surgical intervention, Vascular surgery, Surgical treatment of thrombosis, cholecystectomy, Partial gastric resection, transabdominal hysterectomy, Percutaneous transluminal coronary angioplasty, Percutaneous transluminal angioplasty, Coronary artery bypass, tooth Extirpation, Extirpation of milk teeth, pulpectomy, pulsative cardiopulmonary bypass, tooth Extraction, teeth Extraction, cataract extraction, Electrocoagulation, endourological intervention, episiotomy, Etmoidotomiya, Complications after tooth extraction

Code CAS 50-78-2

Characteristics of Acetylsalicylic acid

White small needle crystals or light crystalline powder, odorless or with a weak odor, weakly acid taste. It is slightly soluble in water at room temperature, soluble in hot water, easily soluble in ethanol, solutions of caustic and carbonic acid.

Pharmacology

Pharmacological action - anti-inflammatory, antipyretic, antiaggregational, analgesic.

Inhibits cyclooxygenase (COX (cyclooxygenase) -1 and COX-2) and irreversibly inhibits the cyclooxygenase pathway of arachidonic acid metabolism, blocks the synthesis of PG (PGA2, PGD2, PGF2αulf, PGE1, PGE2, etc.) and thromboxane. Reduces hyperemia, exudation, permeability of capillaries, activity of hyaluronidase, limits the energy supply of the inflammatory process by inhibiting the production of ATP (adenosine triphosphate). Affects the subcortical centers of thermoregulation and pain sensitivity. Reduction of the content of PG (mainly PGE1) in the center of thermoregulation leads to a decrease in body temperature due to the expansion of the vessels of the skin and increased sweating. The analgesic effect is due to the influence on the centers of pain sensitivity, as well as the peripheral anti-inflammatory action and the ability of salicylates to reduce the algogenic effect of bradykinin. Reduction of thromboxane A2 in platelets leads to irreversible suppression of aggregation, somewhat dilates the blood vessels. Antiaggregant effect persists for 7 days after a single dose. A number of clinical studies have shown that a significant inhibition of the adhesion of blood platelets is achieved at doses up to 30 mg. Increases the fibrinolytic activity of plasma and reduces the concentration of vitamin K-dependent clotting factors (II, VII, IX, X). Stimulates the excretion of uric acid, as its reabsorption in the tubules of the kidneys is disturbed.

After ingestion sufficiently sucked. In the presence of enteric coating (resistant to the action of gastric juice and does not allow the absorption of acetylsalicylic acid in the stomach) is absorbed in the upper part of the small intestine. During absorption, it undergoes presystemic elimination in the intestinal wall and in the liver (deacetylated). The absorbed part is very quickly hydrolyzed by special esterases, so T1 / 2 acetylsalicylic acid is no more than 15-20 minutes. In the body it circulates (75-90% in association with albumin) and is distributed in tissues as an anion of salicylic acid. Cmax is reached after about 2 hours. With proteins of the blood plasma, acetylsalicylic acid is practically not bound. When biotransformation in the liver formed metabolites, found in many tissues and urine. Excretion of salicylates is carried out mainly by active secretion in the tubules of the kidneys in unmodified form and in the form of metabolites. Excretion of unchanged substance and metabolites depends on the pH of urine (with alkalinization of urine ionization of salicylates increases, their reabsorption worsens and excretion increases significantly).

Application of Acetylsalicylic acid

CHD, the presence of several risk factors for IHD (ischemic heart disease), painless myocardial ischemia, unstable angina, myocardial infarction (to reduce the risk of repeated myocardial infarction and death after myocardial infarction), repeated transient ischemia of the brain and ischemic stroke in men, prosthetic heart valves prophylaxis and treatment of thromboembolism), balloon coronary angioplasty, and stent placement (reducing the risk of repeated stenosis and treatment of secondary coronary artery dissection), as well as with non-atherosclerotic coronary artery disease (Kawasaki disease), aortoarteritis (Takayasu's disease), valvular mitral heart defects and atrial fibrillation, mitral valve prolapse (thromboembolism prophylaxis), recurrent thromboembolism of the pulmonary artery, Dressler's syndrome, lung infarction, acute thrombophlebitis. Fever with infectious and inflammatory diseases. Pain syndrome of mild and moderate intensity of various genesis, incl. thoracic radicular syndrome, lumbago, migraine, headache, neuralgia, toothache, myalgia, arthralgia, algodismenorea. In clinical immunology and allergology, it is used in gradually increasing doses for prolonged "aspirin" desensitization and the formation of stable tolerance for NSAIDs (nonsteroidal anti-inflammatory drugs) in patients with "aspirin" asthma and "aspirin" triad.

According to indications rheumatism, rheumatic chorea, rheumatoid arthritis, infectious-allergic myocarditis, pericarditis - is currently used very rarely.

Contraindications

Hypersensitivity, incl. "Aspirin" triad, "aspirin" asthma; hemorrhagic diathesis (haemophilia, von Willebrand's disease, telangiectasia), exfoliating aortic aneurysm, heart failure, acute and recurrent erosive-ulcer diseases of the digestive tract, gastrointestinal bleeding, acute renal or hepatic insufficiency, initial hypoprothrombinemia, vitamin K deficiency , thrombocytopenia, thrombotic thrombocytopenic purpura, glucose-6-phosphate dehydrogenase deficiency, pregnancy (I and III trimester), breastfeeding, childhood and adolescence up to 15 years when used as an antipyretic agent (risk of developing Reye's syndrome in children with fever on the background of viral diseases).

Restrictions for use

Hyperuricemia, nephrolithiasis, gout, gastric and duodenal ulcer (in the anamnesis), severe violations of liver and kidney function, bronchial asthma, COPD, nasal polyposis, uncontrolled hypertension.

pregnancy and lactation

The use of large doses of salicylates in the first trimester of pregnancy is associated with an increased frequency of fetal development defects (cleft palate, heart defects). In the II trimester of pregnancy, salicylates can only be prescribed taking into account the risk and benefit assessment. The appointment of salicylates in the III trimester of pregnancy is contraindicated.

Salicylates and their metabolites penetrate into breast milk in small amounts. The accidental intake of salicylates during lactation is not accompanied by the development of adverse reactions in the child and does not require the cessation of breastfeeding. However, with prolonged use or administration in high doses, breast-feeding should be discontinued.

Side effects of Acetylsalicylic acid

From the cardiovascular system and blood (hematopoiesis, hemostasis): thrombocytopenia, anemia, leukopenia.

On the part of the digestive tract (gastrointestinal tract): NSAIDs (non-steroidal anti-inflammatory drugs) -gastropathy (dyspepsia, epigastric pain, heartburn, nausea and vomiting, severe bleeding in the digestive tract), decreased appetite.

Allergic reactions: hypersensitivity reactions (bronchospasm, laryngeal edema and urticaria), the formation of "aspirin" bronchial asthma and "aspirin" triad (eosinophilic rhinitis, recurrent nasal polyposis, hyperplastic sinusitis) on the basis of the hapten mechanism.

Other: impaired liver and / or kidney function, Reye's syndrome in children (encephalopathy and acute fatty liver disease with rapid development of liver failure).

With prolonged use - dizziness, headache, tinnitus, decreased hearing acuity, visual impairment, interstitial nephritis, prerenal azotemia with increased blood creatinine and hypercalcemia, papillary necrosis, acute renal failure, nephrotic syndrome, blood diseases, aseptic meningitis, enhancement symptoms of congestive heart failure, edema, increased levels of aminotransferases in the blood.

Interaction

Increases the toxicity of methotrexate, reducing its renal clearance, the effects of narcotic analgesics (codeine), oral antidiabetics, heparin, indirect anticoagulants, thrombolytic agents and platelet aggregation inhibitors, reduces the effect of uricosuric drugs (benzbromarone, sulfinpyrazone), antihypertensives, diuretics spironolactone, furosemide). Paracetamol, caffeine increase the risk of side effects. Glucocorticoids, ethanol and ethanol containing drugs increase the negative effect on the mucosa of the gastrointestinal tract and increase the clearance. Increases the concentration of digoxin, barbiturates, lithium salts in plasma. Antatsida containing magnesium and / or aluminum, slow down and worsen the absorption of acetylsalicylic acid. Myelotoxic drugs increase manifestations of hematotoxicity of acetylsalicylic acid.

Overdose

May occur after a single dose of a large dose or with prolonged use. If a single dose is less than 150 mg / kg, acute poisoning is considered easy, 150-300 mg / kg - moderate, with higher doses - heavy.

Symptoms: salicylism syndrome (nausea, vomiting, tinnitus, visual impairment, dizziness, severe headache, general malaise, fever - a poor prognostic sign in adults). More severe poisoning - stupor, convulsions and coma, non-cardiogenic pulmonary edema, severe dehydration, violations of the acid-base state (first - respiratory alkalosis, then - metabolic acidosis), kidney failure and shock.

In chronic overdose, the concentration in the plasma is poorly correlated with the severity of intoxication. The highest risk of developing chronic intoxication is observed in elderly people with a dose of more than 100 mg / kg / day for several days. In children and elderly patients, the initial signs of salicylism are not always noticeable, so it is advisable to periodically determine the concentration of salicylates in the blood. A level above 70 mg% indicates moderate or severe poisoning; above 100 mg% - about extremely severe, prognostically unfavorable. If moderate poisoning is required, hospitalization is necessary for at least 24 hours.

Treatment: provocation of vomiting, the appointment of activated carbon and laxatives, monitoring of KHS and electrolyte balance; depending on the state of metabolism - the introduction of sodium bicarbonate, sodium citrate solution or sodium lactate. The increase in reserve alkalinity increases the excretion of acetylsalicylic acid by alkalinizing urine. Urine alkalization is indicated at salicylate levels above 40 mg%, is provided by intravenous infusion of sodium hydrogen carbonate - 88 meq per 1 liter of 5% glucose solution, at a rate of 10-15 ml / kg / h. Recovery of bcc and induction of diuresis (achieved by the introduction of bicarbonate in the same dose and dilution, repeat 2-3 times); it should be borne in mind that intensive fluid infusion of the elderly patient can lead to pulmonary edema. It is not recommended to use acetazolamide for alkalinization of urine (can cause acidemia and enhance the toxic effect of salicylates). Hemodialysis is indicated at a salicylate level of more than 100-130 mg%, and in patients with chronic poisoning - 40 mg% and lower in the presence of indications (refractory acidosis, progressive deterioration, severe CNS damage, pulmonary edema and kidney failure). With pulmonary edema - IVL with a mixture enriched with oxygen, in the positive pressure mode at the end of exhalation; To treat edema of the brain, hyperventilation and osmotic diuresis are used.

Routes of administration

Inside.

Precautions for Acetylsalicylic acid

It is undesirable to use together with other NSAIDs and glucocorticoids. For 5-7 days before surgery, it is necessary to cancel taking (to reduce bleeding during surgery and in the postoperative period).

The likelihood of developing NSAID-gastropathy decreases with the appointment after eating, using tablets with buffer additives or covered with a special enteric coating. The risk of hemorrhagic complications is considered to be the lowest when applied at doses <100 mg / day.

It should be borne in mind that in predisposed patients, acetylsalicylic acid (even in small doses) reduces the excretion of uric acid from the body and can lead to the development of an acute attack of gout.

During prolonged therapy, it is recommended to perform a regular blood test and examine the feces for latent blood. In connection with the observed cases of hepatogenic encephalopathy is not recommended for the management of febrile syndrome in children.

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