Aggrenox: Dual-Antiplatelet Therapy for Stroke Prevention
Aggrenox
| Product dosage: 225mg | |||
|---|---|---|---|
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| 360 | $0.80
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Synonyms | |||
Aggrenox is a prescription medication specifically formulated for secondary stroke prevention in patients who have experienced a transient ischemic attack (TIA) or ischemic stroke. It combines two antiplatelet agents—aspirin and dipyridamole—in an extended-release formulation to provide complementary mechanisms of action. This combination therapy is designed to reduce the risk of recurrent cerebrovascular events by inhibiting platelet aggregation through multiple pathways, offering a robust approach to long-term vascular protection. Clinical evidence supports its efficacy in reducing stroke risk compared to monotherapy with either component alone.
Features
- Contains a fixed-dose combination of 25 mg aspirin and 200 mg dipyridamole in extended-release capsules
- Designed for twice-daily dosing to maintain consistent antiplatelet effects
- Utilizes a proprietary extended-release technology for dipyridamole to ensure stable plasma concentrations
- Available in capsule form for oral administration
- Manufactured under strict pharmaceutical quality control standards
Benefits
- Significantly reduces the risk of recurrent stroke in patients with prior TIA or ischemic stroke
- Provides dual antiplatelet action through complementary mechanisms (cyclooxygenase-1 inhibition and phosphodiesterase inhibition)
- Offers convenient twice-daily dosing that supports medication adherence
- Demonstrates superior efficacy compared to aspirin monotherapy in clinical trials
- Provides 24-hour platelet inhibition coverage with maintained therapeutic effect
- Reduces the risk of vascular death in high-risk patient populations
Common use
Aggrenox is primarily indicated for secondary prevention of ischemic stroke in patients who have experienced a transient ischemic attack (TIA) or completed ischemic stroke. It is prescribed to reduce the risk of recurrent cerebrovascular events by inhibiting platelet aggregation through dual mechanisms. The medication is typically used as long-term maintenance therapy rather than for acute treatment. Healthcare providers may consider Aggrenox particularly for patients who require more comprehensive antiplatelet therapy than aspirin alone but for whom more potent combinations might carry excessive bleeding risk.
Dosage and direction
The recommended adult dosage is one capsule taken orally twice daily, approximately 12 hours apart. Capsules should be swallowed whole with a full glass of water and should not be chewed or crushed. Administration with food may help minimize potential gastrointestinal discomfort. The medication is typically taken in the morning and evening, maintaining consistent timing to ensure stable antiplatelet effects. Dosage adjustment is not typically required for elderly patients, but careful monitoring is advised. Treatment duration is generally long-term unless contraindications develop.
Precautions
Patients should be carefully evaluated for bleeding risk before initiation and during treatment. Regular monitoring of complete blood count is recommended, particularly during the first few months of therapy. Use with caution in patients with hepatic impairment, renal impairment, or pre-existing bleeding disorders. Patients should be advised to report any signs of bleeding, unusual bruising, or blood in stool promptly. Caution is warranted when co-administering with other antiplatelet agents, anticoagulants, or NSAIDs. The medication should be used cautiously in patients with severe coronary artery disease due to potential for coronary steal phenomenon.
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; severe hepatic impairment; severe renal failure (CrCl <30 mL/min); third trimester of pregnancy; and concomitant use with methotrexate at doses greater than 15 mg per week.
Possible side effects
Common adverse reactions include headache (approximately 15-39% of patients), dyspepsia (14-18%), abdominal pain (8-12%), nausea (8-12%), diarrhea (6-9%), and vomiting (4-7%). Less frequent side effects may include dizziness, fatigue, and arthralgia. Serious adverse effects include bleeding complications (ranging from minor epistaxis to major gastrointestinal bleeding), hypersensitivity reactions, bronchospasm in aspirin-sensitive patients, and cardiovascular effects including angina exacerbation in susceptible individuals.
Drug interaction
Significant interactions occur with anticoagulants (warfarin, direct oral anticoagulants) increasing bleeding risk; other antiplatelet agents (clopidogrel, prasugrel) potentially compounding antiplatelet effects; NSAIDs increasing gastrointestinal bleeding risk; methotrexate reducing renal clearance and increasing toxicity; ACE inhibitors potentially diminished antihypertensive effect; and acetazolamide increasing dipyridamole concentrations. Healthcare providers should conduct thorough medication reconciliation before initiation.
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 is important for maintaining antiplatelet effect, so patients should be counseled on strategies to support regular dosing.
Overdose
Symptoms may include ringing in the ears, dizziness, sweating, nausea, vomiting, headache, hyperventilation, and bleeding complications. Severe overdose may lead to metabolic acidosis, hyperthermia, hypoglycemia, convulsions, coma, and cardiovascular collapse. Management involves immediate medical attention, gastric lavage if presented early, activated charcoal administration, and supportive care including monitoring of coagulation parameters. There is no specific antidote; treatment focuses on symptomatic management and bleeding control.
Storage
Store at room temperature (20-25°C or 68-77°F) in the original container with the lid tightly closed. Protect from moisture and excessive heat. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging. Do not transfer capsules to other containers, as this may affect stability. Discard any medication that appears discolored or shows signs of capsule damage.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Aggrenox is a prescription medication that should be used only under the supervision of a qualified healthcare professional. Patients should not initiate, discontinue, or change dosage without consulting their physician. The prescribing information provided here may not include all possible uses, directions, precautions, or interactions. Always refer to the official prescribing information and consult with a healthcare provider for personalized medical advice.
Reviews
Clinical studies demonstrate that Aggrenox reduces the relative risk of recurrent stroke by approximately 22-37% compared to aspirin alone, with number needed to treat of approximately 30-50 to prevent one stroke over two years. The European Stroke Prevention Study 2 (ESPS-2) showed significant efficacy in stroke prevention, though with a higher incidence of headache as a side effect. Many neurologists consider it a valuable option for secondary stroke prevention, particularly in patients who tolerate the medication well. Patient experiences vary, with some reporting excellent tolerance while others discontinue due to headache or gastrointestinal effects.