Algorithm for increasing oral aspirin dose from 81 mg to 325 mg in an adult patient with NSAID hypersensitivity
Algorithm for increasing oral aspirin dose from 81 mg to 325 mg in an adult patient with NSAID hypersensitivity
For important information on the safe use of these protocols (eg, appropriate settings, indications, and contraindications), refer to the UpToDate topic on introduction of aspirin to patients with aspirin hypersensitivity requiring cardiovascular interventions.
NSAID: nonsteroidal anti-inflammatory drug.
* 81 mg is the common dose for low-dose aspirin in the United States. In many other countries, 100 mg is the common low-dose.
¶ If patient was not premedicated for aspirin introduction in the previous 24 hours, then give montelukast 10 mg at least one hour before beginning the procedure. If asthma is not well-controlled, give prednisone 40 mg orally at least two hours before.
Δ Symptoms should be treated if they occur:
Albuterol for wheezing, chest tightness, or cough
Oxymetazoline or other nasal decongestant spray for nasal obstruction
If severe symptoms occur at a certain dose, that dose should be repeated, and the protocol should be continued after 60 minutes of observation. Patients usually do not react again to the same dose when it is repeated. ◊ If symptoms develop, give:
Montelukast 10 mg
Cetirizine 10 mg orally or diphenhydramine 50 mg intravenously or orally, and
Prednisone 40 mg orally or methylprednisolone 40 mg intravenously
Then, continue the protocol without repeating steps.
