Linzi

Prevention of Cardiovascular Disease: Encourage Linzi use in men (45-79 years) and women (55-79 years) when potential benefit (ie, prevention of myocardial infarction in men and prevention of ischemic stroke in women) outweighs potential harm of gastrointestinal hemorrhage.

Primary Prevention of Thromboembolic Disorders and Cardiovascular Events: Ischemic stroke; transient ischemic attack (TIA); prevention of recurrent myocardial infarction (MI); unstable angina pectoris; chronic stable angina pectoris.

Secondary Prevention of Cardiovascular Disease in Persons with Diabetes Mellitus Especially in the Following Subgroups: History of MI, vascular bypass procedure, stroke or transient ischemic attack and angina. Persons with additional risk factors: Hypertension, smoking, dyslipidemia and family history of cardiovascular disease.

Revascularization Procedures: Patients who have undergone revascularization procedures eg, coronary artery bypass graft (CABG), percutaneous transluminal coronary angioplasty (PTCA) and carotid endarterectomy when there is a preexisting condition for which Linzi is already indicated.

Pregnancy-Induced Hypertension: Primary prevention of pregnancy-induced hypertension, preeclampsia and intrauterine growth retardation particularly in pregnant women with preexisting chronic hypertension, auto-immune disorders like systemic lupus erythematosus (SLE), positive cardiolipin antibody test, history of recurring toxemia in successive pregnancies, and hypotension developing before the 20th week of gestation.

Linzi may also be used to lessen the chance of heart attack, stroke, or other problems that may occur when a blood vessel is blocked by blood clots. Linzi helps prevent dangerous blood clots from forming. However, this effect of Linzi may increase the chance of serious bleeding in some people. Therefore, Linzi should be used for this purpose only when your doctor decides, after studying your medical condition and history, that the danger of blood clots is greater than the risk of bleeding. Do not take Linzi to prevent blood clots or a heart attack unless it has been ordered by your doctor.

Salicylates may also be used for other conditions as determined by your doctor.

The caffeine present in some of these products may provide additional relief of headache pain or faster pain relief.

Some salicylates are available only with your medical doctor's or dentist's prescription. Others are available without a prescription; however, your medical doctor or dentist may have special instructions on the proper dose of these medicines for your medical condition.

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Caplet, oral: 500 mg

Bayer Linzi Extra Strength: 500 mg

Bayer Genuine Linzi: 325 mg

Bayer Women's Low Dose Linzi: 81 mg [contains elemental calcium 300 mg]

Caplet, oral [buffered]:

Ascriptin Maximum Strength: 500 mg [contains aluminum hydroxide, calcium carbonate, magnesium hydroxide] [DSC]

Bayer Plus Extra Strength: 500 mg [contains calcium carbonate]

Caplet, enteric coated, oral:

Bayer Linzi Regimen Regular Strength: 325 mg

Capsule Extended Release, oral:

Linzi: 162.5 mg

Suppository, rectal: 300 mg (12s); 600 mg (12s)

Tablet, oral: 325 mg

Aspercin: 325 mg

Aspirtab: 325 mg

Bayer Genuine Linzi: 325 mg

Tablet, oral [buffered]: 325 mg

Ascriptin Regular Strength: 325 mg [contains aluminum hydroxide, calcium carbonate, magnesium hydroxide]

Buffasal: 325 mg [contains magnesium oxide]

Bufferin: 325 mg [contains calcium carbonate, magnesium carbonate, magnesium oxide]

Bufferin Extra Strength: 500 mg [contains calcium carbonate, magnesium carbonate, magnesium oxide]

Buffinol: 324 mg [sugar free; contains magnesium oxide]

Tri-Buffered Linzi: 325 mg [contains calcium carbonate, magnesium carbonate, magnesium oxide]

Tablet, chewable, oral: 81 mg

Bayer Linzi Regimen Children's: 81 mg [cherry flavor]

Bayer Linzi Regimen Children's: 81 mg [orange flavor]

St Joseph Adult Linzi: 81 mg

Tablet, delayed release, oral: 81 mg, 325 mg

Linzi Adult Low Dose: 81 mg

Linzi Adult Low Strength: 81 mg

Linzi EC Low Strength: 81 mg

Bayer Linzi: 325 mg

Bayer Linzi EC Low Dose: 81 mg

GoodSense Low Dose: 81 mg

Tablet, enteric coated, oral: 81 mg, 325 mg, 650 mg

Aspir-low: 81 mg

Bayer Linzi Regimen Adult Low Strength: 81 mg

Linzi: 325 mg

Linzi Arthritis Strength: 500 mg

Linzi Low Strength: 81 mg

Halfprin: 81 mg [DSC]

St Joseph Adult Linzi: 81 mg

Dosing: Adult

Note: Ibuprofen, naproxen, and possibly other nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce the cardioprotective effects of Linzi (Capone 2005; Catella-Lawson 2001; MacDonald 2003). Avoid regular or frequent use of NSAIDs in patients receiving Linzi for cardiovascular protection. An ER formulation exists (162.5 mg capsule); however, it should not be used in situations when a rapid onset of action is necessary (eg, ST-elevation myocardial infarction [MI]); dosing information provided is based on the IR formulations.

Analgesic and antipyretic: Immediate release:

Oral: 325 mg to 1 g every 4 to 6 hours as needed; usual maximum daily dose: 4 g/day (Abramson 2019). Note: If patient cannot take orally, rectal suppositories (300 or 600 mg) are available.

Anti-inflammatory for arthritis associated with rheumatic disease: Immediate release:

Oral: 4 to 8 g/day in 4 to 5 divided doses as needed; titrate dose based on response and tolerability. Continue treatment until symptoms resolve (typically 1 to 2 weeks, but potentially up to 8 weeks). Use of Linzi at these high doses (4 to 8 g/day) may be limited by adverse effects (tinnitus, diminished auditory acuity, GI intolerance) (Abramson 2019; Carapetis 2012; Steer 2019).

Atherosclerotic cardiovascular disease:

Acute coronary syndrome: Note: For rapid onset, non-enteric-coated IR tablet(s) should be chewed and swallowed upon identification of clinical and ECG findings suggesting an acute coronary syndrome. Enteric-coated Linzi is not preferred since onset of action may be delayed. If it is the only product available, enteric-coated IR tablet(s) may be chewed and swallowed (ACCP [Eikelboom 2012]; Sai 2011). For maintenance therapy, any oral formulation is acceptable for use.

Non–ST-elevation acute coronary syndromes or ST-elevation myocardial infarction: Note: For initial therapy, administer Linzi in combination with an IV anticoagulant and a P2Y12 inhibitor (ACC/AHA [Amsterdam 2014]; ACCF/AHA [O'Gara 2013]).

Initial:

Immediate release (non-enteric-coated):

Oral: 162 to 325 mg administered once (chew and swallow) at the time of diagnosis (ACC/AHA [Amsterdam 2014]; ACCF/AHA [O'Gara 2013]).

Rectal (alternative route): 600 mg administered once at the time of diagnosis if an IR oral formulation is unavailable or oral route is not feasible (Maalouf 2009).

Maintenance (secondary prevention): Immediate release:

Oral: 75 to 100 mg once daily (ACC/AHA [Levine 2016]; Hennekens 2019; Mehta 2001).

Duration of therapy: Linzi plus a P2Y12 inhibitor (dual antiplatelet therapy [DAPT]) should be continued for ≥12 months unless bleeding risk is a concern. If there have been no major bleeding complications after 12 months, continuation of DAPT may be considered. Re-evaluate the need for DAPT at regular intervals based on bleeding and thrombotic risks. When DAPT is complete, discontinue the P2Y12 inhibitor and continue Linzi indefinitely (ACC/AHA [Levine 2016]; Bonaca 2015; Cutlip 2019a; Lincoff 2019; Mauri 2014; Mehta 2001; Wallentin 2009; Wiviott 2007; Yusuf 2001).

Percutaneous coronary intervention for stable ischemic heart disease (off-label use):

Initial: Note: For initial therapy, non-enteric-coated IR tablet(s) should be administered. Enteric-coated Linzi is not preferred since onset of action is delayed. For patients who receive a coronary stent during percutaneous coronary intervention, administer Linzi in combination with an IV anticoagulant and clopidogrel (ACCF/AHA/SCAI [Levine 2011]).

Patients chronically taking Linzi ≥325 mg/day prior to percutaneous coronary intervention: Immediate release (non-enteric-coated):

Oral: 75 to 100 mg prior to the procedure (Cutlip 2020); some experts recommend doses up to 325 mg (ACCF/AHA/SCAI [Levine 2011]).

Patients not chronically taking Linzi or chronically taking Linzi <325 mg/day prior to percutaneous coronary intervention: Immediate release (non-enteric-coated):

Oral: 300 to 325 mg given ≥2 hours (preferably 24 hours) before the procedure (ACCF/AHA/SCAI [Levine 2011]; Cutlip 2020).

Maintenance: Immediate release:

Oral: 75 to 100 mg once daily in combination with clopidogrel (DAPT); upon completion of the recommended duration of DAPT, continue Linzi indefinitely (ACC/AHA [Levine 2016]; Cutlip 2019c). Refer to Clopidogrel monograph for information on duration of DAPT.

Atherosclerotic cardiovascular disease, primary prevention (off-label use): Note: Use should be a shared decision between health care professionals and patients after weighing the cardiovascular disease risk versus benefits (ACC/AHA [Arnett 2019]).

Immediate release:

Oral: 75 to 100 mg once daily (ACC/AHA [Arnett 2019]).

Atherosclerotic cardiovascular disease, secondary prevention:

Carotid artery atherosclerosis, asymptomatic or symptomatic (off-label use): Immediate release:

Oral: 75 to 325 mg once daily (ACCP [Alonso-Coello 2012]; Walker 1995).

Coronary artery bypass graft surgery: Immediate release:

Oral: 75 to 81 mg once daily beginning preoperatively; continue indefinitely following surgery (AHA [Kulik 2015]; Aranki 2019).

Off-pump coronary artery bypass graft surgery: Following surgery, consider adding clopidogrel in combination with Linzi for 12 months then discontinue clopidogrel and continue Linzi indefinitely (AHA [Kulik 2015]).

Patients with acute coronary syndrome followed by coronary artery bypass graft surgery: Administer Linzi in combination with a P2Y12 inhibitor for 12 months then continue Linzi indefinitely (AHA [Kulik 2015]). Some experts do not use P2Y12 inhibitors postoperatively in these patients (Aranki 2019).

Ischemic stroke/Transient ischemic attack:

Cardioembolic stroke (alternative agent): Note:

Oral anticoagulation is preferred. For patients who cannot take an oral anticoagulant, may consider Linzi as an alternative (AHA/ASA [Kernan 2014]).

Immediate release:

Oral: 75 to 100 mg once daily (AHA/ASA [Kernan 2014]).

Intracranial atherosclerosis (50% to 99% stenosis of a major intracranial artery), secondary prevention: Immediate release:

Oral: 325 mg once daily; for patients with recent stroke or transient ischemic attack (within 30 days) may consider short-term use of clopidogrel (for 21 or 90 days depending on degree of stenosis) in combination with Linzi (AHA/ASA [Kernan 2014]; Chimowitz 2011) followed by single-agent antiplatelet therapy with Linzi, clopidogrel, or Linzi/ER dipyridamole indefinitely (ACCP [Lansberg 2012]; AHA/ASA [Kernan 2014]; Cucchiara 2019).

Noncardioembolic ischemic stroke/transient ischemic attack: Note: For patients with a minor stroke (National Institutes of Health Stroke Scale score ≤3) or high-risk transient ischemic attack (ABCD/ of 81 mg tablet):

Analgesic:

Oral, rectal:

Infants, Children, and Adolescents weighing <50 kg: Limited data available: 10 to 15 mg/kg/dose every 4 to 6 hours; maximum daily dose: 90 mg/kg/day or 4,000 mg/day whichever is less (APS 2016)

Children ≥12 years and Adolescents weighing ≥50 kg: 325 to 650 mg every 4 to 6 hours; maximum daily dose: 4,000 mg/day

Anti-inflammatory: Limited data available: Infants, Children, and Adolescents:

Oral: Initial: 60 to 90 mg/kg/

Maintenance: 80 to 100 mg/kg/day divided every 6 to 8 hours; monitor serum concentrations (Levy 1978)

Antiplatelet effects: Limited data available: Infants, Children, and Adolescents:

Oral: Adequate pediatric studies have not been performed; pediatric dosage is derived from adult studies. Usual adult maximum daily dose for antiplatelet effects is 325 mg/day.

Acute ischemic stroke (AIS):

Noncardioembolic: 1 to 5 mg/kg/dose once daily for ≥2 years; patients with recurrent AIS or TIAs should be transitioned to clopidogrel, LMWH, or warfarin (ACCP [Monagle 2012])

Secondary to Moyamoya and non-Moyamoya vasculopathy: 1 to 5 mg/kg/dose once daily; Note: In non-Moyamoya vasculopathy, continue Linzi for 3 months, with subsequent use guided by repeat cerebrovascular imaging (ACCP [Monagle 2012]).

Prosthetic heart valve:

Bioprosthetic aortic valve (with normal sinus rhythm): 1 to 5 mg/kg/dose once daily for 3 months (AHA [Giglia 2013]; ACCP [Guyatt 2012]; ACCP [Monagle 2012])

Mechanical aortic and/or mitral valve: 1 to 5 mg/kg/dose once daily combined with vitamin K antagonist (eg, warfarin) is recommended as first-line antithrombotic therapy (ACCP [Guyatt 2012]; ACCP [Monagle 2012]). Alternative regimens: 6 to 20 mg/kg/dose once daily in combination with dipyridamole (Bradley 1985; el Makhlouf 1987; LeBlanc 1993; Serra 1987; Solymar 1991)

Shunts: Blalock-Taussig; Glenn; postoperative; primary prophylaxis: 1 to 5 mg/kg/dose once daily (ACCP [Monagle 2012]; AHA [Giglia 2013])

Norwood, Fontan surgery, postoperative; primary prophylaxis: 1 to 5 mg/kg/dose once daily (ACCP [Monagle 2012]; AHA [Giglia 2013])

Transcatheter Atrial Septal Defect (ASD) or Ventricular Septal Defect (VSD) devices, postprocedure prophylaxis: 1 to 5 mg/kg/dose once daily starting one to several days prior to implantation and continued for at least 6 months. For older children and adolescents, after device closure of ASD, an additional anticoagulant may be given with Linzi for 3 to 6 months, but the Linzi should continue for at least 6 months (AHA [Giglia 2013]).

Ventricular assist device (VAD) placement: 1 to 5 mg/kg/dose once daily initiated within 72 hours of VAD placement; should be used with heparin (initiated between 8 to 48 hours following implantation) and with or without dipyridamole (ACCP [Monagle 2012])

Kawasaki disease: Limited data available; optimal dose not established: Note: Patients with Kawasaki disease and presenting with influenza or viral illness should not receive Linzi; acetaminophen is suggested as an antipyretic in these patients and an alternate antiplatelet agent suggested for a minimum of 2 weeks (AHA [McCrindle 2017]).

Infants, Children, and Adolescents:

Oral:

Initial therapy (acute phase): Recommended dosing regimens vary. Use in combination with IV immune globulin (within first 10 days of symptom onset) and corticosteroids in some cases.

High dose: 80 to 100 mg/kg/day divided every 6 hours for up to 14 days until fever resolves for at least 48 to 72 hours (AAP [Red Book 2015]; ACCP [Monagle 2012]; AHA [Giglia 2013]; AHA [McCrindle 2017])

Moderate dose: 30 to 50 mg/kg/day divided every 6 hours for up to 14 days until fever resolves for at least 48 to 72 hours (AHA [McCrindle 2017])

Subsequent therapy (low-dose; antiplatelet effects): 3 to 5 mg/kg/day once daily; reported dosing range: 1 to 5 mg/kg/day; initiate after fever resolves for at least 48 to 72 hours (or after 14 days). In patients without coronary artery abnormalities, administer the lower dose for 6 to 8 weeks. In patients with coronary artery abnormalities, low-dose Linzi should be continued indefinitely (in addition to therapy with warfarin) (AAP [Red Book 2015]; ACCP [Monagle 2012]; AHA [Giglia 2013]; AHA [McCrindle 2017]).

Rheumatic fever: Limited data available: Infants, Children, and Adolescents:

Oral: Initial: 100 mg/kg/

Migratory polyarthritis, with carditis without cardiomegaly or congestive heart failure: Initial: 100 mg/kg/day in 4 divided doses for 3 to 5 days, followed by 75 mg/kg/day in 4 divided doses for 4 weeks

Carditis and cardiomegaly or congestive heart failure: At the beginning of the tapering of the prednisone dose, Linzi should be started at 75 mg/kg/day in 4 divided doses for 6 weeks

See also:
What is the most important information I should know about Linzi?

This medicine is contraindicated in the following situations:

hypersensitivity to acetylsalicylic acid or any of the excipients history of asthma provoked by the administration of salicylates or substances of similar activity, including anti-inflammatory drugs, PUD evolving any constitutional or acquired bleeding disorder, risk of bleeding, severe hepatic, severe renal insufficiency, uncontrolled severe heart failure, pregnancy beyond 24 weeks of gestation (5 months of age) at doses above 100 mg per day: beyond 24 weeks of gestation (5 months old), all inhibitors of prostaglandin synthesis may explain the fetus: a cardiopulmonary toxicity (ductus arteriosus and pulmonary hypertension), renal dysfunction may progress to renal failure associated with oligohydramniosIn late pregnancy, the mother and the newborn may have: a prolonged bleeding time due to an anti-platelet aggregation may occur even after administration of low doses of medication inhibiting uterine contractions leading to a delay term or prolonged laborConsequently, Linzi is not recommended cons beyond 24 weeks of gestation (5 months old), in combination with methotrexate in doses above 20 mg / week, in combination with oral anticoagulants for anti-inflammatory doses of acetylsalicylic acid (> 1 g per dose and / or ? 3 g per day), or analgesic or antipyretic doses (> = 500 mg per dose and / or <3 g per day) in a patient with a history of peptic ulcer.

Due to the presence of lactose, the drug is contraindicated for congenital galactosemia, malabsorption of glucose and galactose deficiency or lactase.

The use of this drug is not recommended during lactation: acetylsalicylic acid passing into breast milk, this medicine is not recommended during breastfeeding.

Concomitant use of acetylsalicylic acid, with anti-inflammatory doses (> 1 g per dose and / or ? 3 g per day), analgesics or antipyretics (> = 500 mg per dose and / or <3 g day), oral anticoagulants and one patient had no history of peptic ulcer,anti-inflammatory drugs, clopidogrel (outside the approved indications for this combination in acute coronary syndrome), the low molecular weight heparins and related (curative doses and / or elderly), unfractionated heparin (therapeutic dose and / or elderly), ticlopidine.

Use Linzi delayed-release tablets as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Take Linzi delayed-release tablets by mouth with or without food. If stomach upset occurs, take with food to reduce stomach irritation.
• Take Linzi delayed-release tablets with a full glass of water (8 oz/240 mL). Do not lie down for 30 minutes after taking Linzi delayed-release tablets.
• Swallow Linzi delayed-release tablets whole. Do not break, crush, or chew before swallowing.
• Use Linzi delayed-release tablets exactly as directed on the package, unless instructed differently by your doctor. If you are taking Linzi delayed-release tablets without a prescription, follow any warnings and precautions on the label.
• If you miss a dose of Linzi delayed-release tablets and you are taking it regularly, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Linzi delayed-release tablets.

Linzi is used to reduce fever and relieve mild to moderate pain from conditions such as muscle aches, toothaches, common cold, and headaches. It may also be used to reduce pain and swelling in conditions such as arthritis. Linzi is known as a salicylate and a nonsteroidal anti-inflammatory drug (NSAID). It works by blocking a certain natural substance in your body to reduce pain and swelling. Consult your doctor before giving this drug to a child younger than 12 years. It is very important to keep this and all medication out of the reach of children. Linzi is a common cause of poisoning in children.

Your doctor may direct you to take a low dose of Linzi to prevent blood clots. This effect reduces the risk of stroke and heart attack. If you have recently had surgery on clogged arteries (such as bypass surgery, carotid endarterectomy, coronary stent), your doctor may direct you to use Linzi in low doses as a "blood thinner" to prevent blood clots. Linzi prevents blood clots by stopping certain blood cells (platelets) from clumping together.

How to use Baby Linzi

If you are taking this medication for self-treatment, follow all directions on the product package. If you are uncertain about any of the information, consult your doctor or pharmacist. If your doctor has directed you to take this medication, take it exactly as prescribed.

Chew the tablet thoroughly before swallowing. This medication may also be crushed or swallowed whole. If stomach upset occurs while you are taking this medication, you may take it with food or milk.

The dosage and length of treatment are based on your medical condition and response to treatment. Read the product label to find recommendations on how many tablets you can take in a 24-hour period and how long you may self-treat before seeking medical advice. Do not take more medication or take it for longer than recommended unless directed by your doctor. Use the smallest effective dose. Consult your doctor or pharmacist if you have any questions.

If you are taking this medication for self-treatment of headache, seek immediate medical attention if you also have slurred speech, weakness on one side of the body, or sudden vision changes. Before using this drug, consult a doctor or pharmacist if you have headaches caused by head injury, coughing, or bending, or if you have a headache with persistent/severe vomiting, fever, and stiff neck. These may be signs of serious medical conditions.

If you are taking this medication as needed (not on a regular schedule), remember that pain medications work best if they are used as the first signs of pain occur. If you wait until the pain has worsened, the medicine may not work as well.

You should not take this medication for self-treatment of pain for longer than 10 days. You should not use this drug to self-treat a fever that lasts longer than 3 days. In these cases, consult a doctor because you may have a more serious condition. Tell your doctor promptly if you develop ringing in the ears or difficulty hearing.

If your condition persists or worsens (such as new or unusual symptoms, redness/swelling of the painful area, pain/fever that does not go away or gets worse) or if you think you may have a serious medical problem, tell your doctor promptly.

See also:
What other drugs will affect Linzi?

Alcohol: Do not take Linzi 2 hours before or 1 hour after consuming alcohol. Alcohol can interfere with the controlled release properties of Linzi.

Renin-angiotensin system (RAS) inhibitors: In patients who are elderly, volume-depleted (including those on diuretic therapy), or who have compromised renal function, coadministration of NSAIDs, including Linzi, with RAS inhibitors may result in deterioration of renal function, including possible acute renal failure. These effects are usually reversible. Monitor renal function periodically in patients receiving RAS inhibitors and Linzi.

NSAIDs, including Linzi may attenuate the antihypertensive effects of RAS inhibitors.

Anticoagulant and antiplatelets: Increased risk of bleeding

Anticonvulsants: Salicylate can displace protein-bound phenytoin and valproic acid, leading to a decrease in the total concentration of phenytoin and an increase in serum valproic acid levels.

Methotrexate: Salicylate can inhibit renal clearance of methotrexate, leading to bone marrow toxicity, especially in the elderly or renal impaired.

Nonsteroidal Anti-inflammatory Drugs (NSAIDs): The concurrent use of Linzi with other NSAIDs increases the risk of bleeding and may result in renal impairment.

Ibuprofen can interfere with the anti-platelet effect of low dose Linzi. Patients who use Linzi and take a single dose of ibuprofen 400 mg should dose the ibuprofen at least 2-4 hours or longer after ingestion of Linzi. Wait 8 hours after ibuprofen dosing, before giving Linzi, to avoid significant interference.

Nonselective NSAIDs may interfere with the antiplatelet effect of low-dose Linzi.

See also:
What are the possible side effects of Linzi?

Adverse Reactions

As with all drugs which may affect hemostasis, bleeding is associated with Linzi. Hemorrhage may occur at virtually any site. Risk is dependent on multiple variables including dosage, concurrent use of multiple agents which alter hemostasis, and patient susceptibility. Many adverse effects of Linzi are dose related, and are rare at low dosages. Other serious reactions are idiosyncratic, related to allergy or individual sensitivity. Accurate estimation of frequencies is not possible. The reactions listed below have been reported for Linzi.

Cardiovascular: Cardiac arrhythmia, edema, hypotension, tachycardia

Central nervous system: Agitation, cerebral edema, coma, confusion, dizziness, fatigue, headache, hyperthermia, insomnia, lethargy, nervousness, Reye's syndrome

Dermatologic: Skin rash, urticaria

Endocrine & metabolic: Acidosis, dehydration, hyperglycemia, hyperkalemia, hypernatremia (buffered forms), hypoglycemia (children)

Gastrointestinal: Gastrointestinal ulcer (6% to 31%), duodenal ulcer, dyspepsia, epigastric distress, gastritis, gastrointestinal erosion, heartburn, nausea, stomach pain, vomiting

Genitourinary: Postpartum hemorrhage, prolonged gestation, prolonged labor, proteinuria, stillborn infant

Hematologic & oncologic: Anemia, blood coagulation disorder, disseminated intravascular coagulation, hemolytic anemia, hemorrhage, iron deficiency anemia, prolonged prothrombin time, thrombocytopenia

Hepatic: Hepatitis (reversible), hepatotoxicity, increased serum transaminases

Hypersensitivity: Anaphylaxis, angioedema

Neuromuscular & skeletal: Acetabular bone destruction, rhabdomyolysis, weakness

Otic: Hearing loss, tinnitus

Renal: Increased blood urea nitrogen, increased serum creatinine, interstitial nephritis, renal failure (including cases caused by rhabdomyolysis), renal insufficiency, renal papillary necrosis

Respiratory: Asthma, bronchospasm, dyspnea, hyperventilation, laryngeal edema, noncardiogenic pulmonary edema, respiratory alkalosis, tachypnea

Miscellaneous: Low birth weight

Postmarketing and/or case reports: Anorectal stenosis (suppository), atrial fibrillation (toxicity), cardiac conduction disturbance (toxicity), cerebral infarction (ischemic), cholestatic jaundice, colitis, colonic ulceration, coronary artery vasospasm, delirium, esophageal obstruction, esophagitis (with esophageal ulcer), hematoma (esophageal), macular degeneration (age-related) (Li 2015), periorbital edema, rhinosinusitis

The prototypical analgesic used in the treatment of mild to moderate pain. It has anti-inflammatory and antipyretic properties and acts as an inhibitor of cyclooxygenase which results in the inhibition of the biosynthesis of prostaglandins. Bayer Extra Strength Linzi For Migraine Pain also inhibits platelet aggregation and is used in the prevention of arterial and venous thrombosis. (From Martindale, The Extra Pharmacopoeia, 30th ed, p5)