CLOPIDOGREL + ASPIRIN

Indications & Dose:

Acute coronary syndrome attack

The recommended dose is one tablet once daily

Contraindications:

Hypersensitivity to clopidogrel,• Hypersensitivity to aspirin and/or non-steroidal antiinflammatory agents, • Recent history of gastrointestinal bleeding, Active pathological bleeding such as peptic ulcer or intracranial hemorrhage, or bleeding disorders like hemophilia . 

Side Effects:

The drug is generally well tolerated. Side effects that have been reported include abdominal pain. dyspepsia. gastritis. diarrhea. nausea, vomiting, constipation, gastrointestinal hemorrhage, ulceration, neutropenia, rash, palpitation, syncope, drowsiness, asthenia, neuralgia, paresthesia and vertigo.

Cautions:

Precautions:

Interaction:

Oral anticoagulants: Should be used with caution when anticoagulants are prescribed concurrently, since both aspirin and clopidogrel may depress the concentration of prothrombin in plasma and thereby increase bleeding time.

Hypoglycemic agents: Large doses of salicylates have hypoglycemic action and may enhance the effect of the oral hypoglycemics. Consequently, they should not be given concomitantly; if however this is necessary, the dosage of the hypoglycemic agent must be reduced while the salicylate is given.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): In healthy volunteers receiving naproxen, concomitant administration of clopidogrel was associated with increased occult gastrointestinal blood loss. NSAIDs and clopidogrel should be coadministered with caution. Hypersensitive to NSAIDs.

Uricosuric agents: Although salicylate in larger doses are uricosuric agents, smaller amounts may decrease the uricosuric effects of probenecid, sulfinpyrazone and phenylbutazone. Aspirin may decrease the effects of probenecid, sulfinpyrazone and phenylbutazone.

Spironolactone: Sodium excretion produced by spironolactone may be decreased in the presence of salicylates. Salicylates can produce changes in thyroid function tests. Salicylates should be used with caution in patients with severe hepatic damage, preexisting hypoprothrombinemia or Vitamin K deficiency and in those undergoing surgery

.Alcohol: Has a synergistic effect with aspirin in causing gastrointestinal bleeding.

Corticosteroids: Concomitant administration of aspirin with corticosteroids may increase the risk of gastrointestinal ulceration and may reduce serum salicylate levels.

Pyrazolone derivatives (phenylbutazone, oxyphenbutazone and possibly dipyrone): Concomitant administration may increase the risk of gastrointestinal ulceration.

Urinary alkalinizers: Decrease aspirin effectiveness by increasing the risk of salicylate renal excretion.

Phenobarbital: Decreases aspirin effectiveness by enzyme induction.

Phenytoin, tamoxifen, tolbutamide, torsemide, fluvastatin: At high concentrations in vitro, clopidogrel inhibits P450 (2C9) . Accordingly, clopidogrel may interfere with the metabolism of phenytoin, tamoxifen, tolbutamide, torsemide and fluvastatin, but there are no data with which to predict the magnitude of these interactions. Caution should be observed when any of these drugs is coadministered with clopidogrel. Aspirin may also increase serum levels of phenytoin.

Propranolol: May decrease aspirin’s antiinflammatory action by competing for the same receptors.

Warnings:

Adverse Effects:

Lactations:

Adverse effects are increased in the mother and the fetus following chronic ingestion of aspirin. Because of possible adverse effects on the neonate and the potential for increased matemal blood loss, Should be avoided during the last three months of pregnancy. Should be avoided in nursing mothers because of the possible risk of developing Reye’s syndrome. Regular use of high doses of aspirin could impair platelet function and produce hypoprothrombinemia in infants if neonatal vitamin K levels are low.

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: