Aspirin Dipyridamole

Aspirin Dipyridamole Brand Name– Aggrenox

What is Aspirin Dipyridamole

Aspirin dipyridamole are two different antiplatelet agents used together for secondary stroke prevention.

Aspirin is a salicylate and dipyridamole is a coronary vasodilator with antiplatelet properties. Aggrenox™ combines these two drugs in a fixed dose (200 mg dipyridamole/25 mg aspirin) extended-release formulation.

The combination product is specifically indicated for the prophylaxis of stroke in patients who have sustained a previous stroke or transient ischemic attack (TIA) based on the European Stroke Prevention Study 2 (ESPS2) which included 6602 patients.

The fixed dose combination of aspirin-dipyridamole was twice as effective as either agent alone alone in the secondary prevention of stroke, but did not affect overall mortality in this one-year clinical trial.

Bleeding was more frequent with the combination product compared to extended-release dipyridamole alone, and headache was more frequent compared to aspirin alone.

The Antiplatelet Trialists Collaboration (1988) had previously concluded that dipyridamole and aspirin in combination was not more effective than aspirin, and that dipyridamole monotherapy had no role in the treatment of thromboembolic disorders.

The results of the ESPS2 study support the combined use of aspirin and dipyridamole in the dosage formulation studied for the secondary prevention of stroke in cerebrovascular disorders.

For patients with a history of noncardioembolic TIA or stroke, the American College of Chest Physicians (ACCP) recommends aspirin; dipyridamole as one of several first-line antiplatelet regimens including low-dose aspirin or clopidogrel.

These specific guidelines also suggest that clopidogrel be favored over aspirin; however, this Grade 2B recommendation places a high value on a small reduction in absolute stroke rates, and a lower value on drug expenditures.

For stroke or TIA patients for whom aspirin is indicated to prevent recurrent myocardial infarction (MI) or angina pectoris, the low aspirin dosage in Aggrenox™ may not be adequate for the cardiac indications.

Final FDA approval for Aggrenox™ was granted on November 22, 1999.

Indications

• stroke prophylaxis

For secondary stroke prophylaxis in patients who have had a transient ischemic attack (TIA) or ischemic stroke due to thrombosis

Side Effects

1. abdominal pain
2. agitation
3. alopecia
4. amnesia
5. anemia
6. angina
7. angioedema
8. anorexia
9. aplastic anemia
10. arthralgia
11. asthenia
12. back pain
13. bleeding
14. bronchospasm
15. cerebral edema
16. chest pain (unspecified)
17. cholelithiasis
18. coagulopathy
19. coma
20. confusion
21. cough
22. dehydration
23. diarrhea
24. disseminated intravascular coagulation (DIC)
25. dizziness
26. drowsiness
27. dyspepsia
28. dyspnea
29. ecchymosis
30. elevated hepatic enzymes
31. epistaxis
32. fatigue
33. fetal death
34. fever
35. flushing
36. GI bleeding
37. GI perforation
38. headache
39. hearing loss
40. heart failure
41. hematemesis
42. hematoma
43. hematuria
44. hemoptysis
45. hemorrhoids
46. hepatic failure
47. hepatitis
48. hyperglycemia
49. hyperkalemia
50. hyperuricemia
51. hypoglycemia
52. hypokalemia
53. hypotension
54. hypothermia
55. infection
56. interstitial nephritis
57. intracranial bleeding
58. jaundice
59. laryngeal edema
60. malaise
61. melena
62. metabolic acidosis
63. migraine
64. myalgia
65. nausea
66. palpitations
67. pancreatitis
68. pancytopenia
69. paresthesias
70. peptic ulcer
71. peripheral vasodilation
72. platelet dysfunction
73. prolonged bleeding time
74. proteinuria
75. pruritus
76. pulmonary edema
77. purpura
78. pyrosis (heartburn)
79. rash
80. renal failure (unspecified)
81. renal papillary necrosis
82. renal tubular necrosis
83. Reye’s syndrome
84. rhabdomyolysis
85. seizures
86. sinus tachycardia
87. Stevens-Johnson syndrome
88. supraventricular tachycardia (SVT)
89. syncope
90. tachypnea
91. thrombocytopenia
92. thrombocytosis
93. tinnitus
94. urticaria
95. vasculitis
96. vomiting

Monitoring Parameters

• laboratory monitoring not necessary

Contraindications

• abrupt discontinuation
• acute bronchospasm
• agranulocytosis
• alcoholism
• anemia
• angina
• asthma
• bone marrow suppression
• breast-feeding
• children
• coagulopathy
• coronary artery disease
• diabetes mellitus
• esophagitis
• G6PD deficiency
• gastritis
• geriatric
• GI bleeding
• gout
• head trauma
• hepatic disease
• hyperuricemia
• hypoprothrombinemia
• immunosuppression
• increased intracranial pressure
• infants
• intracranial bleeding
• intramuscular injections
• labor
• myocardial infarction
• nasal polyps
• neonates
• neutropenia
• NSAID hypersensitivity
• obstetric delivery
• orthostatic hypotension
• peptic ulcer disease
• pregnancy
• renal disease
• renal failure
• renal impairment
• Reye’s syndrome
• salicylate hypersensitivity
• surgery
• syncope
• systemic lupus erythematosus (SLE)
• tartrazine dye hypersensitivity
• thrombocytopenia
• tobacco smoking
• urticaria
• viral infection
• vitamin K deficiency

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