Aspirin and dipyridamole

What is Aspirin and dipyridamole?

• Aspirin and dipyridamole (Aggrenox) is a combination antiplatelet agent used to reduce the risk of stroke in patients who have had or are at risk of stroke.

Aspirin-skeletal

Dipyridamole

Dipyridamole ball-and-stick animation

What are the uses of this medicine?

• Aspirin and dipyridamole (Aggrenox) is used to reduce the risk of stroke in patients who have had transient ischemia of the brain or completed ischemic stroke due to thrombosis.

How does this medicine work?

• A fixed combination of aspirin, a cyclooxygenase inhibitor, and dipyridamole, a phosphodiesterase (PDE) inhibitor, with antiplatelet and antithrombotic activities.
• Upon oral administration of aspirin/dipyridamole, aspirin binds to and irreversibly inhibits platelet cyclooxygenase, thereby inhibiting thromboxane A2 formation.
• This prevents platelet aggregation and vasoconstriction.
• Dipyridamole inhibits adenosine uptake by platelets and endothelial cells, triggering an accumulation of cyclic adenosine monophosphate (cAMP), and inhibiting the stimulation of platelet aggregation by agents such as platelet activating factor and collagen.

Who Should Not Use this medicine ?

This medicine cannot be used in patients with:

• Hypersensitivity to any product ingredients.
• Patients with known allergy to NSAIDs.
• Patients with the syndrome of asthma, rhinitis, and nasal polyps.

What drug interactions can this medicine cause?

• Tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take.

Be sure to mention any of the following:

• acetazolamide (Diamox)
• ambenonium (Mytelase)
• angiotensin-converting enzyme inhibitors such as benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), moexipril (Univasc), quinapril (Accupril), ramipril (Altace), and trandolapril (Mavik)
• anticoagulants ('blood thinners') such as warfarin (Coumadin) and heparin
• beta-blockers such as acebutolol (Sectral), atenolol (Tenormin), betaxolol (Kerlone), bisoprolol (Zebeta), carteolol (Cartrol), carvedilol (Coreg), labetalol (Normodyne), metoprolol (Lopressor), nadolol (Corgard), penbutolol (Levatol), pindolol (Visken), propranolol (Inderal), sotalol (Betapace), and timolol (Blocadren)
• diabetes medications such as acetohexamide (Dymelor), chlorpropamide (Diabinese), glimepiride (Amaryl), glipizide (Glucotrol), glyburide (DiaBeta, Micronase, Glynase), repaglinide (Prandin), tolazamide (Tolinase), and tolbutamide (Orinase)
• diuretics ('water pills') such as amiloride (Midamor), bumetanide (Bumex), chlorothiazide (Diuril), chlorthalidone (Hygroton), ethacrynic acid (Edecrin), furosemide (Lasix), hydrochlorothiazide (Hydrodiuril), indapamide (Lozol), metolazone (Zaroxolyn), spironolactone (Aldactone), torsemide (Demadex), and triamterene (Dyrenium)
• methotrexate (Folex, Mexate, Rheumatrex)
• neostigmine (Prostigmin)
• nonsteroidal anti-inflammatory drugs (NSAIDs) such as celecoxib (Celebrex), choline salicylate (Arthropan), diclofenac (Cataflam), diflunisal (Dolobid), etodolac (Lodine), fenoprofen (Nalfon), flurbiprofen (Ansaid), ibuprofen (Advil, Motrin, Nuprin, others), indomethacin (Indocin), ketoprofen (Orudis, Oruvail), ketorolac (Toradol), magnesium salicylate (Nuprin Backache, Doan's), meclofenamate, mefenamic acid (Ponstel), meloxicam (Mobic), nabumetone (Relafen), naproxen (Aleve, Naprosyn), oxaprozin (Daypro), piroxicam (Feldene), sulindac (Clinoril), and tolmetin (Tolectin)
• phenytoin (Dilantin)
• probenecid (Benemid)
• pyridostigmine (Mestinon)
• sulfinpyrazone(Anturane)
• valproic acid and related drugs (Depakene, Depakote)

Is this medicine FDA approved?

• Initial U.S. Approval: 1999

How should this medicine be used?

Recommended dosage:

• One capsule twice daily (morning and evening) with or without food.
• In case of intolerable headaches during initial treatment, switch to one capsule at bedtime and low-dose aspirin in the morning; resume BID dosing within one week.
• Aggrenox cannot be interchangeable with the individual components of aspirin and dipyridamole tablets.

Administration:

• The combination of aspirin and extended-release dipyridamole comes as a capsule to take by mouth.
• It is usually taken twice a day, one capsule in the morning and one in the evening.
• Aspirin and extended-release dipyridamole should be swallowed whole.
• Do not open, crush, break, or chew the capsules.
• The combination of aspirin and extended-release dipyridamole decreases the risk of having a stroke but does not eliminate that risk.
• Continue to take aspirin and extended-release dipyridamole even if you feel well.

What are the dosage forms and brand names of this medicine?

This medicine is available in fallowing doasage form:

• As Capsule: 25 mg aspirin/200 mg extended-release dipyridamole

This medicine is available in fallowing brand namesː

• Aggrenox

What side effects can this medication cause?

The most common side effects of this medicine include:

• headache
• dyspepsia
• abdominal pain
• nausea
• diarrhea
• muscle and joint pain
• tiredness
• heartburn

What special precautions should I follow?

• The risk of GI bleeding is increased, especially in patients who are heavy alcohol users, have a history of peptic ulcer, or have coagulation abnormalities due to liver disease or vitamin K deficiency.
• As with other antiplatelets, there is a risk of intracranial hemorrhage.
• Avoid use in patients with severe hepatic or renal insufficiency.
• Aggrenox can cause fetal harm when administered to a pregnant woman, especially in the third trimester
• Dipyridamole has a vasodilatory effect. Chest pain may be precipitated or aggravated in patients with underlying coronary artery disease who are receiving dipyridamole.
• Dipyridamole produces peripheral vasodilation, which can exacerbate pre-existing hypotension.
• AGGRENOX capsules are not interchangeable with the individual components of aspirin and dipyridamole tablets.
• Some patients may experience headaches upon treatment initiation; these are usually transient. In case of intolerable headaches, tell the patient to contact their physician.
• Tell patients that AGGRENOX capsules should be swallowed whole, and not chewed or crushed. If you miss a dose, continue with your next dose on your regular schedule. Do not take a double dose.
• Both dipyridamole and aspirin are excreted in human milk. Exercise caution when AGGRENOX capsules are administered to a nursing woman.

What to do in case of emergency/overdose?

• Overdosage of AGGRENOX is likely to be dominated by signs and symptoms of dipyridamole overdose.

Symptoms of overdosage may include:

• warm feeling
• flushes
• sweating
• restlessness
• feeling of weakness
• dizziness
• tachycardia
• salicylism
• tinnitus
• hyperthermia
• hypovolemia

Management of overdosage:

• Treatment of overdose consists primarily of supporting vital functions, increasing drug elimination, and correcting acid-base disturbances. Consider gastric emptying and/or lavage as soon as possible after ingestion, even if the patient has vomited spontaneously.
• After lavage and/or emesis, administration of activated charcoal as a slurry may be beneficial if less than 3 hours have passed since ingestion.
• Maintain fluid and electrolyte balance.
• Administer replacement fluid intravenously and augment with correction of acidosis.
• Treatment may require the use of a vasopressor.
• Infusion of glucose may be required to control hypoglycemia.
• Administration of xanthine derivatives (e.g., aminophylline) may reverse the hemodynamic effects of dipyridamole overdose.
• In patients with renal insufficiency or in cases of life-threatening intoxication, dialysis is usually required to treat salicylic overdose, However since dipyridamole is highly protein bound, dialysis is not likely to remove dipyridamole.
• Exchange transfusion may be indicated in infants and young children.

Can this medicine be used in pregnancy?

• Pregnancy Category D.
• AGGRENOX can cause fetal harm when administered to a pregnant woman, especially in the third trimester.

Can this medicine be used in children?

• Safety and effectiveness of AGGRENOX in pediatric patients have not been studied.

What are the active and inactive ingredients in this medicine?

Active ingredient:

• aspirin
• dipyridamole

Inactive ingredients:

• acacia
• aluminum stearate
• silicon dioxide
• starch, corn
• dimethicone
• hypromellose
• hypromellose phthalate
• lactose monohydrate
• methacrylic acid - methyl methacrylate copolymer
• cellulose, microcrystalline
• povidone
• stearic acid
• sucrose
• talc
• tartaric acid
• titanium dioxide
• triacetin
• gelatin
• ferric oxide red
• ferric oxide yellow
• water

Who manufactures and distributes this medicine?

Distributed by:

• Boehringer Ingelheim Pharmaceuticals, Inc.
• Ridgefield, CT USA

What should I know about storage and disposal of this medication?

• Store at 25°C (77°F); excursions permitted to 15°-30°C (59°-86°F).
• Protect from excessive moisture.

• Dailymed label info on Aspirin and dipyridamole
• FDA Aspirin and dipyridamole

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Aspirin and dipyridamole Resources
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