Aggrenox is a combination antiplateatelet agent specifically formulated for the secondary prevention of ischemic stroke and transient ischemic attacks (TIAs). It combines two established pharmacological agents—aspirin and dipyridamole—in an extended-release formulation designed to provide complementary mechanisms of action. This combination therapy targets multiple pathways of platelet aggregation, offering a robust approach to reducing the risk of recurrent cerebrovascular events. Clinical evidence supports its efficacy in patients who have experienced prior strokes or TIAs, positioning it as a cornerstone in neurology and vascular protection protocols.

Features

• Contains 25 mg aspirin and 200 mg extended-release dipyridamole per capsule
• Proprietary extended-release formulation for consistent dipyridamole delivery
• Dual mechanism targeting cyclooxygenase-1 and phosphodiesterase inhibition
• B.i.d. dosing regimen for sustained antiplatelet effect
• Enteric-coated to minimize gastric irritation from aspirin component

Benefits

• Significantly reduces relative risk of recurrent stroke compared to aspirin monotherapy
• Provides complementary antiplatelet inhibition through two distinct pathways
• Offers convenient twice-daily dosing to support medication adherence
• Demonstrated long-term efficacy in maintaining vascular protection
• Suitable for patients requiring more aggressive antiplatelet therapy than single agents
• Established safety profile with extensive clinical trial documentation

Common use

Aggrenox is primarily indicated for secondary prevention of ischemic stroke in patients who have experienced prior thrombotic cerebrovascular events. It is commonly prescribed by neurologists, cardiologists, and vascular specialists for patients with demonstrated cerebrovascular disease where monotherapy with aspirin alone may provide insufficient protection. The medication is typically initiated following stabilization after an acute ischemic stroke or TIA, often as part of a comprehensive secondary prevention strategy that may include blood pressure management, lipid control, and lifestyle modifications.

Dosage and direction

The recommended adult dosage is one capsule taken orally twice daily, approximately 12 hours apart. Capsules should be swallowed whole with a full glass of water and should not be crushed, chewed, or opened. Administration should occur on an empty stomach, at least one hour before or two hours after meals, to optimize dipyridamole absorption and maintain consistent plasma concentrations. Treatment is typically long-term unless significant adverse effects or contraindications develop. Dosage adjustment is not typically required for elderly patients, but careful monitoring is advised in those with renal or hepatic impairment.

Precautions

Patients should be carefully evaluated for bleeding risk before initiation. Regular monitoring of complete blood count is recommended, particularly during the first few months of therapy. Caution is advised in patients with history of peptic ulcer disease, hepatic impairment, or renal dysfunction. The aspirin component may provoke bronchospasm in patients with asthma. Patients undergoing surgical procedures should inform their surgeon about Aggrenox use, as temporary discontinuation may be required 5-7 days prior to elective surgery. Alcohol consumption should be limited due to increased risk of gastrointestinal bleeding.

Contraindications

Hypersensitivity to aspirin, dipyridamole, or any component of the formulation; asthma induced by salicylates or NSAIDs; active pathological bleeding such as peptic ulcer disease or intracranial hemorrhage; severe hepatic impairment; severe renal failure (CrCl <30 mL/min); third trimester of pregnancy; concomitant use with methotrexate at doses >15 mg/week.

Possible side effects

Common adverse reactions (≥5% incidence) include headache, dyspepsia, abdominal pain, nausea, diarrhea, and vomiting. Headache typically diminishes in frequency and intensity with continued therapy. Less frequent but potentially serious side effects include gastrointestinal bleeding (1-2%), hemorrhagic stroke (<1%), severe thrombocytopenia, and hypersensitivity reactions including bronchospasm. Patients should promptly report signs of bleeding, unusual bruising, black stools, or persistent headache.

Drug interactions

Concurrent use with anticoagulants (warfarin, dabigatran, rivaroxaban, apixaban) or other antiplatelet agents increases bleeding risk. NSAIDs may enhance gastrointestinal toxicity and reduce cardioprotective effects of aspirin. ACE inhibitors may have diminished antihypertensive effect when combined with aspirin. Dipyridamole may potentiate effects of adenosine. Aspirin may increase methotrexate toxicity and reduce uricosuric effect of probenecid. Concomitant use with SSRIs/SNRIs may increase bleeding tendency.

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next scheduled dose. In that case, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed administration. Maintain consistent timing to ensure continuous antiplatelet protection.

Overdose

Symptoms may include ringing in the ears, dizziness, nausea, vomiting, sweating, warm sensation, restlessness, tachycardia, hypotension, and bleeding manifestations. Severe overdose may lead to metabolic acidosis, hyperthermia, respiratory alkalosis, hypoglycemia, convulsions, and coma. Management requires immediate medical attention with gastric lavage if recent ingestion, activated charcoal administration, and supportive care including fluid replacement and correction of acid-base balance. Hemodialysis may be effective for salicylate removal.

Storage

Store at room temperature (20-25°C or 68-77°F) in the original container with lid tightly closed. Protect from moisture and excessive heat. Keep out of reach of children and pets. Do not use beyond the expiration date printed on the packaging. Do not transfer capsules to other containers as this may affect the extended-release properties.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Individual patient needs may vary based on specific medical conditions, concomitant medications, and other factors. Healthcare professionals should exercise clinical judgment when prescribing Aggrenox, considering the complete medical profile of each patient. Patients should not initiate, discontinue, or modify therapy without consulting their healthcare provider.

Reviews

Clinical trials demonstrate Aggrenox reduces relative risk of recurrent stroke by approximately 22% compared to aspirin alone and 19% compared to dipyridamole alone based on the ESPS-2 study. The PROFESS trial confirmed non-inferiority to clopidogrel in stroke prevention. Many neurologists consider it first-line therapy for secondary stroke prevention, particularly in patients with higher risk profiles. Patient tolerance varies, with some experiencing initial headaches that typically resolve within several weeks of continued therapy. Adherence rates are generally favorable due to the b.i.d. dosing schedule compared to more frequent regimens.