It is advisable to take the tablets before meals with plenty of liquid. The tablets are taken once a day. The drug is intended for long-term use. The duration of therapy is determined by the doctor. Primary prevention of acute myocardial infarction in the presence of risk factors: 100 mg per day. Prevention of re-infarction, stable and unstable angina pectoris: 100-300 mg per day. Unstable angina pectoris (if acute myocardial infarction is suspected): an initial dose of 100-300 mg (the first tablet must be chewed for faster absorption) should be taken by the patient as soon as possible after the development of acute myocardial infarction is suspected. In the next 30 days after the development of myocardial infarction, a dose of 200-300 mg per day should be maintained. After 30 days, appropriate therapy should be prescribed to prevent recurrent myocardial infarction. Prevention of stroke and transient cerebrovascular accident: 100-300 mg per day. Prevention of thromboembolism after surgery and invasive interventions on the vessels: 100-300 mg per day. Prevention of deep vein thrombosis and thromboembolism of the pulmonary artery and its branches: 100-200 mg per day. If you skip taking one or more doses of a drug, the patient should take the missed pill as soon as he remembers it, and then continue taking it as usual. To avoid doubling the dose, do not take the missed pill if the next pill is approaching. Features of the action of the drug at the first admission and at its cancellation. No peculiarities of the action of the drug at the first administration and its cancellation were observed.

Hypersensitivity to acetylsalicylic acid, excipients in the drug and other NSAIDs; bronchial asthma induced by the intake of salicylates and other NSAIDs; a combination of bronchial asthma, recurrent polyposis of the nose and paranasal sinuses and ASA intolerance; erosive and ulcerative lesions of the gastrointestinal tract in the acute stage; gastrointestinal bleeding; hemorrhagic diathesis; combined use with methotrexate at a dose of 15 mg per week or more; pregnancy (I and III trimesters); lactation period; children and adolescents (up to 18 years old); severe renal failure (CC less than 30 ml / min); severe hepatic impairment (class B or higher on the Child-Pugh scale); chronic heart failure of III-IV functional class according to NYHA classification.

From the digestive system: the most common are nausea, heartburn, vomiting, abdominal pain; rarely - ulcers of the mucous membrane of the stomach and duodenum; very rarely - perforated ulcers of the mucous membrane of the stomach and duodenum, gastrointestinal bleeding (with appropriate clinical symptoms and laboratory changes), transient abnormalities in liver function with increased activity of hepatic transaminases. From the side of the hematopoietic system: the appointment of ASA is accompanied by an increased risk of bleeding due to the inhibitory effect of ASA on platelet aggregation. An increase in the frequency of perioperative (intra- and postoperative) bleeding, hematomas, nosebleeds, bleeding gums, bleeding from the urinary tract was recorded. There are reports of serious cases of bleeding, which include gastrointestinal and cerebral hemorrhages (especially in hypertensive patients who have not reached target blood pressure and / or are receiving concomitant anticoagulant therapy), which in some cases can be life-threatening ... Bleeding can lead to the development of acute or chronic posthemorrhagic / iron deficiency anemia (for example, due to latent bleeding) with the corresponding clinical and laboratory signs and symptoms (asthenia, pallor, hypoperfusion). There are reports of cases of hemolysis and hemolytic anemia in patients with severe glucose-6-phosphate dehydrogenase deficiency. Allergic reactions: hypersensitivity reactions with corresponding laboratory and clinical manifestations, such as asthmatic syndrome (bronchospasm), mild to moderate reactions from the skin, respiratory tract, gastrointestinal tract and cardiovascular system, including symptoms such as skin rash, pruritus , urticaria, Quincke's edema, rhinitis, edema of the nasal mucosa, rhinitis, cardio-respiratory distress syndrome, as well as severe reactions, including anaphylactic shock. From the side of the central nervous system: there are reports of cases of dizziness, hearing loss, headache, tinnitus, which may be a sign of drug overdose. From the urinary system: there are reports of cases of development of impaired renal function and acute renal failure.

With the simultaneous use of ASA, it enhances the effect of the drugs listed below; if it is necessary to simultaneously prescribe ASA with the listed agents, consider the need to reduce the dose of these drugs: methotrexate by reducing renal clearance and displacing it from its connection with proteins; the combination of ASA with methotrexate is accompanied by an increased incidence of side effects from the hematopoietic organs; the use of the drug in conjunction with methotrexate is contraindicated if the dose of the latter exceeds 15 mg per week and, possibly, with caution when the dose of methotrexate is less than 15 mg per week; heparin and indirect anticoagulants due to dysfunction of platelets and displacement of indirect anticoagulants from the connection with proteins; with simultaneous use with anticoagulants, thrombolytic and antiplatelet agents (ticlopidine), there is an increase in the risk of bleeding as a result of the synergism of the main therapeutic effects of the drugs used; with simultaneous use with drugs with anticoagulant, thrombolytic or antiplatelet effect, there is an increase in the damaging effect on the mucous membrane of the gastrointestinal tract; selective serotonin reuptake inhibitors, which can lead to an increased risk of bleeding from the upper gastrointestinal tract (synergism with ASA); digoxin due to a decrease in its renal excretion, which can lead to its overdose; hypoglycemic agents for oral administration (sulfonylurea derivatives) and insulin due to the hypoglycemic properties of ASA itself in high doses and displacement of sulfonylurea derivatives from the connection with blood plasma proteins; this must be borne in mind when prescribing ASA to patients with diabetes mellitus receiving the listed drugs; when applied simultaneously with valproic acid, its toxicity increases due to displacement from the connection with blood plasma proteins; NSAIDs and salicylic acid derivatives in high doses (increased risk of ulcerogenic effect and bleeding from the gastrointestinal tract as a result of synergistic action); ethanol (alcoholic beverages) (increased risk of damage to the gastrointestinal mucosa and prolonged bleeding time as a result of the mutual enhancement of the effects of ASA and ethanol). The simultaneous appointment of ASA in high doses can weaken the effect of the drugs listed below (if it is necessary to simultaneously prescribe ASA with the listed drugs, you should consider the need to adjust the dose of the drugs listed below): any diuretics (when used together with ASA in high doses, a decrease in the glomerular filtration rate is noted as a result of a decrease in the synthesis of prostaglandins in the kidneys); ACE inhibitors (there is a dose-dependent decrease in the glomerular filtration rate (GFR) as a result of inhibition of prostaglandins, which have a vasodilating effect, respectively, a weakening of the hypotensive effect. prescribed to patients for the treatment of chronic heart failure. This effect is also manifested when used in conjunction with ASA in large doses); drugs with uricosuric action - benzbromarone, probenecid (decrease in the uricosuric effect due to competitive suppression of renal tubular excretion of uric acid). With simultaneous use with ibuprofen, antagonism is observed with respect to irreversible inhibition of platelets due to the action of ASA, which leads to a decrease in the cardioprotective effects of ASA. Therefore, the combination of ASA with ibuprofen is not recommended in patients with an increased risk of cardiovascular disease. With simultaneous use with systemic corticosteroids (with the exception of hydrocortisone or other corticosteroids used for replacement therapy of Addison's disease), an increase in the elimination of salicylates and, accordingly, a weakening of their action is noted. With the combined use of GCS and salicylates, it should be remembered that during treatment the level of salicylates in the blood is reduced, and after the abolition of GCS, an overdose of salicylates is possible.

Salicylate intoxication (develops when ASA is taken at a dose of more than 100 mg / kg / day for more than 2 days) may result from prolonged use of toxic doses of the drug as part of an incorrect therapeutic use of the drug (chronic intoxication) or a single accidental or deliberate intake of a toxic dose of the drug an adult or a child (acute intoxication). The symptoms of chronic intoxication with salicylic acid derivatives are nonspecific and often difficult to diagnose. Mild intoxication usually develops only after repeated use of large doses of the drug and is manifested by dizziness, tinnitus, hearing loss, increased sweating, nausea and vomiting, headache and confusion. These symptoms disappear after reducing the dose of the drug. Tinnitus can appear when the concentration of ASA in blood plasma is from 150 to 300 μg / ml. More severe symptoms appear when the concentration of ASA in the blood plasma is above 300 μg / ml. The main manifestation of acute intoxication is a severe violation of the acid-base state, the manifestations of which can vary depending on the age of the patient and the severity of intoxication. In children, the development of metabolic acidosis is most typical. Treatment of intoxication is carried out in accordance with accepted standards and depends on the severity of intoxication and the clinical picture and should be aimed mainly at accelerating the elimination of the drug and restoring the water-electrolyte balance and acid-base state. Overdose symptoms from mild to moderate severity: dizziness, tinnitus, hearing impairment, increased sweating, nausea, vomiting, headache, confusion, profuse sweating, tachypnea, hyperventilation, respiratory alkalosis. Treatment: gastric lavage, repeated intake of activated carbon, forced alkaline diuresis, restoration of water-electrolyte balance and acid-base state. Overdose symptoms from moderate to severe: respiratory alkalosis with compensatory metabolic acidosis, hyperpyrexia (extremely high body temperature); respiratory disorders (hyperventilation, noncardiogenic pulmonary edema, respiratory depression, asphyxia); disorders of the cardiovascular system (heart rhythm disturbances, arterial hypotension, inhibition of cardiac activity); violations of water and electrolyte balance (dehydration, impaired renal function from oliguria up to development to renal failure, characterized by hypokalemia, hypernatremia, hyponatremia); violation of glucose metabolism (hyperglycemia, hypoglycemia / especially in children /, ketoacidosis); tinnitus, deafness; gastrointestinal bleeding; hematological disorders (from inhibition of platelet aggregation to coagulopathy, prolongation of prothrombin time, hypoprothrombinemia); neurological disorders (toxic encephalopathy and depression of the central nervous system / drowsiness, confusion, coma, convulsions). Treatment: immediate hospitalization in specialized departments for emergency therapy - gastric lavage, repeated intake of activated charcoal, forced alkaline diuresis, hemodialysis, restoration of water-electrolyte balance and acid-base state, symptomatic therapy.