Actions: irreversibly inhibits platelet cyclo-oxygenase, inhibits the formation of platelet-aggregating substance thromboxane A2 platelet aggregation, acts on hypothalamus heat-regulating center to reduce fever. Indications: treatment of mild to moderate pain, inflammation, and fever; adjunctive treatment of Kawasaki disease; used for prophylaxis of myocardial infarction and transient ischemic episodes. Dose (adult): analgesic and antipyretic: 325-650 mg every 4-6 hours PO or rectal; anti-inflammatory: 2.4-5.4 g/day PO in divided doses; myocardial infarction prophylaxis: 75-325 mg/day PO. Dose (ped): analgesic and antipyretic: 10-15 mg/kg PO/PR every 4-6 hours (up to 60-80 mg/kg/24 hr); antiinflammatory: 60-100 mg/kg/day PO divided every 6-8 hours; Kawasaki disease: 80-100 mg/kg/24 hrs PO in 4 divided doses during febrile phase until defervesces, then decrease to 3-5 mg/kg/24 hrs PO every am (continue for at least 8 weeks). Clearance: primarily by hepatic microsomal enzymes. Adverse effects: may cause GI upset, allergic reactions, liver toxicity, decreased platelet aggregation. Comments: active peptic ulcer disease (use rectal suppository); use caution if history of hypersensitivity or allergy, bleeding disorders, severe hepatic disease, renal dysfunction, gastritis, gout; associated with Reye's syndrome (do not use in patients <16 years of age for treatment of chicken pox or flu-like symptoms).
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