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 antiinflammatory 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 1 hour before beginning the procedure. If asthma is not well controlled, give prednisone 40 mg orally at least 2 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.

Courtesy of Ronald A Simon, MD.

Graphic 112849 Version 4.0

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Algorithm for increasing oral aspirin dose from 81 mg to 325 mg in an adult patient with NSAID hypersensitivity