What is the maximum dose of aspirin (acetylsalicylic acid) for pediatric patients?

Maximum Dose of Aspirin in Pediatric Patients

For pediatric patients requiring aspirin therapy, the maximum recommended dose depends on the indication, with antiplatelet therapy typically using 1-5 mg/kg/day and anti-inflammatory therapy (such as in Kawasaki disease) using up to 80-100 mg/kg/day during acute phases. 1

Dosing Guidelines by Indication

Antiplatelet Therapy

• For antiplatelet effects, the recommended dose is 1-5 mg/kg/day 1
• For stroke prevention specifically, an initial dose of 3-5 mg/kg/day is reasonable 1
• If dose-related side effects occur, a reduction to 1-3 mg/kg/day may be considered 1

Anti-inflammatory Therapy (Kawasaki Disease)

• During the acute inflammatory phase: 80-100 mg/kg/day divided into 4 doses for up to 14 days 1
• After fever resolution or after the acute phase: transition to low-dose aspirin (1-5 mg/kg/day) for antiplatelet effect for 6-8 weeks 1

Age-Specific Considerations

• Neonates: Clearance of aspirin is slower in neonates, potentially placing them at higher risk for bleeding for longer periods 1
• Children <2 years: May require higher antiplatelet doses (up to 5 mg/kg/day) for adequate platelet inhibition 2
• Children >2 years: May achieve adequate platelet inhibition with approximately 3 mg/kg/day 2

Safety Considerations

Toxicity Thresholds

• Single ingestions of >150 mg/kg warrant referral to emergency department 3
• Severe toxicity risk increases significantly with doses >140 mg/kg/day for several days 4
• Median doses associated with major effects range from 132.3-172.8 mg/kg 3

Reye Syndrome Risk

• Annual influenza vaccination and verification of varicella vaccination status is recommended for children on long-term aspirin therapy 1
• Aspirin should be withheld during suspected influenza or varicella infections 1
• Consider alternative antiplatelet medication during high-risk periods 1

Drug Interactions

• Concomitant use of ibuprofen may antagonize the irreversible platelet inhibition induced by aspirin 1
• Ibuprofen should generally be avoided in children with coronary aneurysms taking aspirin for its antiplatelet effects 1

Monitoring

• The PFA-100 and VerifyNow assays are sometimes used to monitor aspirin therapy in pediatric patients, but there are no data supporting improved outcomes from this practice 1
• Laboratory assessment may be warranted in younger children to prevent under or overdosing 2

Special Populations

Kawasaki Disease with Coronary Aneurysms

• For children with moderate or giant coronary aneurysms following Kawasaki disease, warfarin in addition to low-dose aspirin is suggested 1
• Long-term aspirin therapy may be continued indefinitely in children who develop coronary abnormalities 1

Stroke Prevention

• For children with arterial ischemic stroke, aspirin therapy is typically recommended for a minimum of 2 years 1
• For children unable to take aspirin, clopidogrel has been used at doses of 1 mg/kg per day 1