Aggrenox: Dual-Antiplatelet Protection Against Recurrent Stroke
| Product dosage: 225mg | |||
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Synonyms | |||
Aggrenox is a prescription medication specifically formulated to reduce the risk of stroke in patients who have experienced a previous ischemic stroke or transient ischemic attack (TIA). It combines two antiplatelet agents, dipyridamole and aspirin, in a single, extended-release capsule. This unique dual-mechanism approach provides a comprehensive therapeutic strategy aimed at inhibiting platelet aggregation through complementary pathways, offering a robust defense against thrombotic events. By targeting different aspects of platelet function, Aggrenox delivers a synergistic effect that is a cornerstone of secondary stroke prevention protocols, as supported by clinical evidence and expert guidelines in neurology and cardiology.
Features
- Each hard capsule contains 200 mg of extended-release dipyridamole and 25 mg of immediate-release aspirin.
- Formulated for twice-daily oral administration, ensuring consistent 12-hour therapeutic coverage.
- The dipyridamole component is in an extended-release form to maintain stable plasma concentrations.
- The aspirin component provides immediate antiplatelet and anti-inflammatory effects.
- Available in bottle packaging with desiccant to maintain stability and potency.
- Manufactured under strict pharmaceutical quality control standards.
Benefits
- Significantly reduces the relative risk of recurrent stroke compared to aspirin alone, as demonstrated in large-scale clinical trials.
- Provides dual antiplatelet inhibition, targeting both the adenosine reuptake and cyclooxygenase pathways for comprehensive thromboprophylaxis.
- Convenient twice-daily dosing regimen supports patient adherence to long-term secondary prevention therapy.
- Well-established efficacy profile with extensive real-world evidence supporting its use in post-stroke care.
- May be suitable for patients who require an alternative to clopidogrel or other single-agent antiplatelet therapies.
- The combination has been shown to be more effective than either component administered individually.
Common use
Aggrenox is indicated for secondary prevention of ischemic stroke in patients who have experienced a prior thrombotic stroke or transient ischemic attack. It is not intended for the treatment of acute stroke events or for primary prevention in patients without a history of cerebrovascular disease. The medication is typically prescribed as part of a comprehensive management plan that includes lifestyle modifications, management of vascular risk factors such as hypertension and hyperlipidemia, and regular neurological follow-up.
Dosage and direction
The recommended adult dosage is one capsule taken orally twice daily, approximately 12 hours apart, with a full glass of water. The capsules should be swallowed whole and not crushed, chewed, or opened. Administration with food may help minimize potential gastrointestinal discomfort. Treatment is generally continued long-term unless significant adverse effects or contraindications develop. Dosage adjustment is not typically required for elderly patients, but careful monitoring is advised in those with renal or hepatic impairment.
Precautions
Patients should be carefully evaluated for bleeding risk before initiating therapy. Use with caution in patients with history of gastrointestinal ulcers, bleeding disorders, or recent surgical procedures. Regular monitoring of complete blood count may be warranted during prolonged therapy. Caution is advised in patients with severe hepatic or renal impairment, as drug accumulation may occur. Patients should be advised to avoid concurrent use of other NSAIDs or anticoagulants without medical supervision. The medication should be used during pregnancy only if clearly needed and after careful risk-benefit assessment.
Contraindications
Hypersensitivity to aspirin, dipyridamole, or any component of the formulation. Patients with known aspirin-sensitive asthma. Active pathological bleeding such as peptic ulcer disease or intracranial hemorrhage. Combination with anticoagulants like warfarin in most clinical scenarios, unless specifically indicated and closely monitored. Severe hepatic impairment. Children and adolescents with viral infections due to risk of Reye’s syndrome.
Possible side effect
Common adverse reactions include headache (which often diminishes with continued therapy), gastrointestinal discomfort, dyspepsia, nausea, diarrhea, and abdominal pain. Less frequently reported effects include dizziness, fatigue, and vomiting. Serious side effects may include bleeding manifestations (ecchymosis, epistaxis, gastrointestinal bleeding), hypersensitivity reactions, tinnitus, hepatic enzyme elevations, and in rare cases, thrombocytopenia. Patients should be instructed to report any signs of bleeding or severe headache promptly.
Drug interaction
Concomitant use with anticoagulants (warfarin, heparin), other antiplatelet agents, or thrombolytics increases bleeding risk. NSAIDs may potentiate gastrointestinal toxicity and bleeding risk. ACE inhibitors may have diminished antihypertensive effect when combined with aspirin. Dipyridamole may potentiate effects of adenosine. Cholinesterase inhibitors may have reduced efficacy. Antacids may affect aspirin absorption.
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next scheduled dose. In that case, the missed dose should be skipped, and the regular dosing schedule resumed. Patients should not double the dose to make up for a missed administration. Consistent adherence to the prescribed regimen is important for maintaining therapeutic antiplatelet effects.
Overdose
Symptoms may include ringing in ears, dizziness, nausea, vomiting, sweating, hyperventilation, and bleeding manifestations. Severe overdose may lead to metabolic acidosis, hyperthermia, hypoglycemia, convulsions, coma, and cardiovascular collapse. Management requires immediate medical attention with supportive care, gastric lavage if presented early, activated charcoal, and monitoring of acid-base balance. Specific antidotes may include vitamin K for bleeding complications and alkaline diuresis for salicylate toxicity.
Storage
Store at room temperature (20-25°C or 68-77°F) in the original container with the cap tightly closed. Protect from moisture and light. Keep out of reach of children and pets. Do not use if capsules appear damaged or discolored. Properly discard any unused medication after the expiration date.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Treatment decisions should be made by qualified healthcare professionals based on individual patient circumstances. Patients should consult their physician before starting or changing any medication regimen. The prescribing information provided here may not include all possible uses, directions, precautions, or interactions.
Reviews
Clinical studies have demonstrated that Aggrenox reduces the relative risk of recurrent stroke by approximately 22% compared to aspirin alone and by 37% compared to placebo. The ESPRIT trial and ESPS-2 study provide robust evidence supporting its efficacy in secondary stroke prevention. Many neurologists consider it a valuable option, particularly for patients who have experienced stroke while on aspirin monotherapy. Some clinicians note that the headache side effect, while common initially, often resolves with continued use. The combination therapy is generally well-tolerated in long-term use, with most adverse effects being mild to moderate in severity.