Clopidogrel + Aspirin

Generic Details

Generic Name

Clopidogrel-Aspirin

Other Names

  • Clopidogrel and Aspirin Combination

Drug Class

  • Antiplatelet Agent
  • Anti-inflammatory agent

Chemical Formula

C16H16ClNO2S.C9H8O4

Molecular Weight

321.83 g/mol (clopidogrel) and 180.16 g/mol (aspirin)

Mechanism of Action

  • Clopidogrel irreversibly inhibits the P2Y12 subtype of the ADP receptor on platelets, preventing activation and aggregation
  • Aspirin irreversibly inhibits cyclooxygenase-1 (COX-1) enzyme, leading to inhibition of thromboxane A2 synthesis thereby reducing platelet aggregation

Indications

  • Prevention of cardiovascular events in patients with acute coronary syndrome
  • Secondary prevention in patients at high risk of cardiovascular events such as stroke or heart attack

Common Dosage Forms

  • Tablet

Typical Dosage

  • One tablet (75 mg clopidogrel/75 mg aspirin) daily

Pediatric Dosage

  • Safety and efficacy not established in children

Geriatric Dosage

  • Dosage adjustment may be necessary in the elderly population with renal impairment

Side Effects

  • Bleeding
  • Stomach upset or pain
  • Dizziness
  • Headache

Contraindications

  • Hypersensitivity to clopidogrel, aspirin, or any components of the formulation
  • Active bleeding or peptic ulcer disease

Pregnancy Category

  • Category B for clopidogrel
  • Category D for aspirin (avoid in third trimester)

Lactation Safety

  • Clopidogrel is excreted in breast milk, avoid its use during lactation
  • Aspirin is generally considered compatible with breastfeeding

Drug Interactions

  • Increased risk of bleeding with other anticoagulants or NSAIDs
  • Decreased effectiveness with proton pump inhibitors (PPIs)

Overdose Symptoms

  • Increased risk of bleeding
  • Gastrointestinal irritation

Antidote for Overdose

  • Platelet transfusion for clopidogrel overdose
  • Activated charcoal for aspirin overdose

Storage Conditions

  • Store at room temperature (20-25°C)

Pharmacokinetics

  • Absorption: Both medications are well absorbed after oral administration
  • Distribution: Clopidogrel is extensively bound to plasma proteins; aspirin has a smaller protein binding capacity
  • Metabolism: Clopidogrel is metabolized by CYP2C19 to an active metabolite; aspirin is rapidly hydrolyzed to salicylic acid
  • Excretion: Mainly renal for clopidogrel, and both renal and hepatic for aspirin

Precautions

  • Caution in patients with a history of bleeding disorders
  • Monitor closely for signs of bleeding during therapy

Warnings

  • Discontinue treatment before elective surgery if possible to reduce bleeding risk
  • May increase the risk of gastrointestinal bleeding

Others

  • Consult healthcare provider before starting or stopping any medications while on clopidogrel-aspirin combination