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

Interactions

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