Aspirin + Clopidogrel

Aspirin + Clopidogrel is a combination of two antiplatelet medicines used to prevent heart attack and stroke. Aspirin irreversibly inhibits COX-1 in platelets, reducing thromboxane A2 production. Clopidogrel, a prodrug, is converted to an active metabolite that irreversibly binds to the platelet P2Y12 ADP receptor, inhibiting platelet aggregation.

This combination inhibits platelet aggregation through two different pathways, providing enhanced protection against thrombotic events. It is indicated for acute coronary syndrome, recent MI, recent stroke, and peripheral arterial disease.

Common side effects include abdominal pain, diarrhea, bruising, nosebleeds, and increased bleeding tendency.

• Acute Coronary Syndrome (ACS) - non-ST-elevation ACS (UA/NSTEMI) and ST-elevation ACS (STEMI)
• Recent Myocardial Infarction (MI)
• Recent Stroke
• Established Peripheral Arterial Disease (PAD)

Clopidogrel is a prodrug. It is converted to an active metabolite that irreversibly binds to the P2Y12 class of ADP receptors on platelets, inhibiting platelet activation and aggregation. At 75 mg daily, inhibition reaches steady state between Day 3 and Day 7.

Aspirin irreversibly inhibits platelet cyclooxygenase, reducing thromboxane A2 production - a powerful inducer of platelet aggregation and vasoconstriction.

This combination inhibits platelet aggregation through two distinct pathways, providing enhanced antithrombotic effect.

Aspirin inhibits cyclooxygenase (COX-1) in platelets, reducing thromboxane A2 production which promotes platelet aggregation and vasoconstriction. Clopidogrel is converted to an active metabolite that irreversibly binds to the platelet P2Y12 ADP receptor, inhibiting ADP-mediated platelet aggregation and GP IIb/IIIa complex activation.

Adult:

• Maintenance: Clopidogrel 75 mg + Aspirin 75-150 mg (usually 75 mg) once daily
• ACS: Clopidogrel 300 mg loading dose, then 75 mg daily + Aspirin 75-325 mg daily
• Elderly & renal patients: No dose adjustment needed

Take with or without food. Swallow the tablet whole; do not chew or crush. Take at a fixed time daily. Discontinue clopidogrel 7-10 days before elective surgery.

If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue with your regular schedule. Do not double the dose.

• Abdominal pain
• Diarrhea
• Bruise
• Nosebleeds
• Gastrointestinal bleeding
• Increased bleeding tendency
• Indigestion

Rare: Thrombotic Thrombocytopenic Purpura (TTP)

Serious Precautions:

• May prolong bleeding time - be careful while shaving, cutting nails, using sharp objects
• Discontinue 7-10 days before elective surgery
• Contraindicated in active peptic ulcer, haemophilia, haemorrhagic disorders, severe renal/hepatic impairment
• Do not use in children under 12 years (Reye's syndrome risk)
• Contraindicated in 3rd trimester of pregnancy
• Caution in asthma, allergies, nasal polyps
• Avoid alcohol consumption

• Hypersensitivity to aspirin, NSAIDs, or clopidogrel
• Active peptic ulceration
• Active pathological bleeding (peptic ulcer or intracranial hemorrhage)
• Children under 12 years
• Haemophilia or haemorrhagic disorders
• Gout
• Severe renal or hepatic impairment
• Lactation
• 3rd trimester of pregnancy

• Aspirin: Clopidogrel potentiates aspirin's effect
• Heparin: No dose modification needed
• NSAIDs: Increased risk of GI bleeding - use with caution
• Warfarin: Caution with co-administration
• Other antiplatelets/anticoagulants: Increased bleeding risk

[UNSAFE] It is unsafe to consume alcohol with Aspirin + Clopidogrel. Alcohol increases the risk of bleeding.

[CONSULT YOUR DOCTOR] Use in 1st and 2nd trimester only if clearly needed. Contraindicated in 3rd trimester.

[CONSULT YOUR DOCTOR] It is unknown whether clopidogrel is excreted in human milk, but aspirin is excreted. Discontinue during breastfeeding.

Contraindicated in children under 12 years (Reye's syndrome risk).

No dose adjustment needed for elderly patients, but caution is required.

[CAUTION] Use with caution in kidney disease. Not recommended in severe kidney disease.

[CAUTION] Use with caution in liver disease. Not recommended in severe liver disease.

Clopidogrel: Overdose may lead to bleeding complications. Platelet transfusion may be needed.

Aspirin: Moderate intoxication: dizziness, tinnitus, confusion, GI symptoms. Severe: respiratory alkalosis/acidosis, metabolic acidosis, hyperthermia, dehydration. Haemodialysis may be required.

Store below 30°C, in a cool and dry place, protected from light and moisture. Keep out of reach of children.