Aggrenox

Aggrenox is a prescription medication specifically formulated for the secondary prevention of ischemic stroke and transient ischemic attack (TIA). It combines two antiplatelet agents, dipyridamole and aspirin, in an extended-release formulation designed to provide complementary mechanisms of action. This combination therapy targets key pathways in platelet aggregation, offering a robust defense against thrombotic events in high-risk patients. By reducing the risk of subsequent strokes, Aggrenox plays a critical role in long-term cerebrovascular protection strategies, as supported by extensive clinical evidence and guidelines.

Features

• Contains a fixed-dose combination of 200 mg extended-release dipyridamole and 25 mg immediate-release aspirin
• Unique pharmacokinetic profile providing sustained antiplatelet effects
• Specifically designed for secondary stroke prevention
• Available in capsule form for oral administration
• Manufactured under strict pharmaceutical quality standards
• Backed by robust clinical trial data (ESPS-2 study)

Benefits

• Significantly reduces the risk of recurrent stroke compared to aspirin alone
• Provides dual-pathway platelet inhibition for comprehensive protection
• Offers convenient twice-daily dosing for consistent therapeutic coverage
• Demonstrates well-established efficacy in diverse patient populations
• Supported by international stroke prevention guidelines
• May provide superior protection in certain high-risk subgroups

Common use

Aggrenox is primarily indicated for the secondary prevention of ischemic stroke in patients who have experienced a previous stroke or transient ischemic attack. It is particularly valuable in cases where monotherapy with aspirin may provide insufficient protection. The medication is commonly prescribed by neurologists, cardiologists, and vascular specialists as part of a comprehensive stroke prevention strategy that may include lifestyle modifications, blood pressure control, and cholesterol management. Clinical evidence supports its use in both men and women across various age groups, though individual patient factors must always be considered.

Dosage and direction

The standard recommended dosage is one capsule taken orally twice daily, approximately 12 hours apart. Capsules should be swallowed whole with a full glass of water, without crushing, chewing, or opening. Administration with food may help minimize potential gastrointestinal discomfort. Treatment should typically be initiated as soon as the acute phase of a stroke has stabilized, as determined by the treating physician. Dosage adjustments are generally not required for elderly patients, but careful monitoring is advised. The duration of treatment is typically long-term, continuing indefinitely unless contraindications develop or alternative therapies are deemed more appropriate.

Precautions

Patients should be carefully evaluated for bleeding risk factors before initiation and during treatment. Regular monitoring of complete blood count and liver function tests is recommended, particularly during the first few months of therapy. Caution is advised in patients with hepatic impairment, renal dysfunction, or history of peptic ulcer disease. The medication may cause dizziness; patients should be advised against operating machinery until they know how Aggrenox affects them. Special consideration is required in patients scheduled for surgical procedures, with temporary discontinuation typically recommended 5-7 days prior to elective surgery. Patients should be educated about signs of bleeding and instructed to seek immediate medical attention if they occur.

Contraindications

Aggrenox is contraindicated in patients with known hypersensitivity to dipyridamole, aspirin, or any component of the formulation. It must not be used in patients with active pathological bleeding, such as peptic ulcer disease or intracranial hemorrhage. Additional contraindications include asthma induced by NSAIDs or salicylates, severe hepatic impairment, and severe renal failure. The combination is contraindicated in children and adolescents with viral infections due to the risk of Reye’s syndrome. Concomitant use with other NSAIDs or anticoagulants is generally contraindicated unless specifically indicated and carefully monitored.

Possible side effects

The most commonly reported adverse reactions include headache (approximately 39% of patients), gastrointestinal disturbances (dyspepsia, abdominal pain, nausea, diarrhea in 18-37%), and bleeding complications (5-10%). Headaches typically diminish in frequency and intensity after the first week of treatment. Less frequent side effects may include dizziness, fatigue, and flushing. Serious but rare adverse effects include major bleeding events, hypersensitivity reactions, hepatotoxicity, and tinnitus. Patients should report any unusual bruising, bleeding, persistent headache, or signs of allergic reaction to their healthcare provider promptly.

Drug interaction

Aggrenox has significant interaction potential due to its dual antiplatelet action. Concomitant use with anticoagulants (warfarin, dabigatran, rivaroxaban), other antiplatelet agents, or NSAIDs increases bleeding risk substantially. ACE inhibitors may have reduced antihypertensive effect when combined with aspirin component. Dipyridamole may potentiate the effects of adenosine and other vasodilators. The cholinesterase inhibitor effect of dipyridamole may interact with certain anesthetic agents. Aspirin component may interact with methotrexate, valproic acid, and oral hypoglycemic agents. Healthcare providers should conduct thorough medication reconciliation before initiation.

Missed dose

If a dose is missed, patients should take it 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 never take a double dose to make up for a missed one. Maintaining consistent antiplatelet coverage is important for optimal protection, so patients should be encouraged to establish a regular dosing routine. If multiple doses are missed, patients should contact their healthcare provider for guidance on resuming therapy.

Overdose

Overdose may manifest as symptoms related to individual components. Aspirin overdose can cause tinnitus, hearing loss, hyperventilation, metabolic acidosis, and severe electrolyte imbalances. Dipyridamole overdose may result in hypotension, tachycardia, and flushing. In cases of suspected overdose, immediate medical attention is required. Treatment is supportive and symptomatic, including gastric lavage if presented early, activated charcoal administration, and careful monitoring of vital signs and hematological parameters. There is no specific antidote; management focuses on maintaining renal function and correcting metabolic disturbances. Hemodialysis may be considered in severe cases.

Storage

Store at controlled room temperature between 20-25°C (68-77°F), with excursions permitted between 15-30°C (59-86°F). Keep the container tightly closed and protect from moisture. Do not store in bathroom cabinets or other humid areas. Keep out of reach of children and pets. Do not use beyond the expiration date printed on the packaging. Proper disposal of unused medication should follow local regulations, typically through medication take-back programs rather than flushing or throwing in household trash.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Treatment decisions must be made by qualified healthcare professionals based on individual patient circumstances. The prescribing physician should be consulted for complete information regarding indications, contraindications, warnings, precautions, and adverse reactions. Patients should not alter their medication regimen without medical supervision. While every effort has been made to ensure accuracy, medical knowledge evolves continuously, and newer information may supersede what is presented here.

Reviews

Clinical studies consistently demonstrate Aggrenox’s efficacy in stroke prevention. The ESPS-2 trial showed a 37% relative risk reduction in stroke compared to placebo, with superior efficacy to aspirin monotherapy. Many neurologists report positive experiences in clinical practice, noting particularly good outcomes in patients with multiple risk factors. Some patients report initial headache as a challenge, though this typically resolves with continued use. Cost considerations and gastrointestinal side effects are sometimes noted as limitations. Overall, the medication maintains a strong position in stroke prevention guidelines and is widely regarded as an important therapeutic option for appropriate patients.