Aggrenox is a prescription medication specifically formulated for secondary stroke prevention in patients who have experienced a prior ischemic stroke or transient ischemic attack (TIA). It combines two antiplatelet agents, dipyridamole and aspirin, in an extended-release formulation designed to work synergistically to inhibit platelet aggregation, a key mechanism in thrombotic events. This combination therapy represents a clinically validated approach to reducing the risk of recurrent cerebrovascular incidents by targeting multiple pathways of platelet activation and adhesion, offering a robust therapeutic option within evidence-based neurology and cardiology guidelines.

Features

• Contains a fixed-dose combination of 200 mg extended-release dipyridamole and 25 mg immediate-release aspirin per capsule
• Utilizes a specialized pharmaceutical design for controlled dipyridamole release and rapid aspirin absorption
• Administered orally twice daily, approximately 12 hours apart
• Available in bottle configurations of 60 and 100 capsules
• Manufactured under strict pharmaceutical quality control standards
• Includes desiccant in packaging to maintain stability

Benefits

• Significantly reduces the relative risk of recurrent stroke compared to aspirin monotherapy
• Provides dual-pathway antiplatelet inhibition through complementary mechanisms of action
• Offers convenient twice-daily dosing that supports medication adherence
• Demonstrates well-established efficacy in large-scale clinical trials with long-term follow-up data
• Provides a standardized formulation that eliminates the need for separate antiplatelet medications
• Supported by comprehensive clinical guidelines for secondary stroke prevention

Common use

Aggrenox is primarily indicated for the secondary prevention of ischemic stroke in patients who have experienced a prior thrombotic stroke or transient ischemic attack. It is particularly appropriate for patients who require more aggressive antiplatelet therapy than aspirin alone but for whom oral anticoagulants may not be suitable. The medication is commonly prescribed by neurologists, cardiologists, and vascular specialists as part of a comprehensive secondary prevention strategy that includes risk factor modification, lifestyle changes, and management of comorbid conditions such as hypertension, diabetes, and hyperlipidemia.

Dosage and direction

The recommended adult dosage is one capsule taken orally twice daily, approximately every 12 hours. Capsules should be swallowed whole with a full glass of water and should not be chewed, crushed, or opened. Administration with food may help minimize potential gastrointestinal discomfort. The medication is typically taken in the morning and evening, with consistency in timing being important for maintaining stable antiplatelet effects. Treatment is generally continued long-term unless significant adverse effects develop or contraindications emerge. Dosage adjustment is not typically required for elderly patients, but careful monitoring is advised.

Precautions

Patients should be carefully evaluated for bleeding risk factors before initiation and during treatment. Regular monitoring of complete blood count is recommended, particularly during the first few months of therapy. Caution is advised in patients with hepatic impairment, as dipyridamole is extensively metabolized by the liver. Those with severe renal impairment (creatinine clearance <30 mL/min) should use Aggrenox with caution due to potential accumulation of metabolites. Patients should be advised to avoid other NSAIDs and aspirin-containing products unless specifically directed by their physician. The medication should be used with particular caution in patients scheduled for surgical procedures; discussion with the surgical team regarding temporary discontinuation may be necessary.

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 aspirin-sensitive asthma or other aspirin-exacerbated respiratory disease. Additional contraindications include active pathological bleeding, such as peptic ulcer disease or intracranial hemorrhage; severe hepatic failure; and severe renal failure. The medication is contraindicated in children and adolescents with viral infections due to the risk of Reye’s syndrome associated with aspirin component. It should not be administered to patients taking methotrexate in doses greater than 15 mg per week.

Possible side effects

The most commonly reported adverse reactions include headache (approximately 39% of patients), which often diminishes with continued treatment; gastrointestinal disturbances such as dyspepsia (18%), abdominal pain (17%), nausea (16%), and diarrhea (13%); and dizziness (9%). Less frequent but potentially serious side effects may include bleeding complications such as gastrointestinal bleeding, bruising, epistaxis, and prolonged bleeding time. Allergic reactions ranging from urticaria to anaphylaxis may occur, particularly in aspirin-sensitive individuals. Cardiovascular effects including hypotension, tachycardia, and chest pain have been reported in some patients.

Drug interaction

Aggrenox has significant interaction potential with numerous medication classes. It may increase the risk of bleeding when used concomitantly with anticoagulants (warfarin, dabigatran, rivaroxaban), other antiplatelet agents (clopidogrel, prasugrel), selective serotonin reuptake inhibitors, and SNRIs. Aspirin component may increase methotrexate toxicity and decrease the effectiveness of ACE inhibitors. Dipyridamole may potentiate the blood pressure-lowering effects of antihypertensive medications and counteract the effects of cholinesterase inhibitors. Concurrent use with other NSAIDs may increase gastrointestinal bleeding risk. Adenosine administration for cardiac stress testing may require adjustment due to dipyridamole’s effect on adenosine uptake.

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, the missed dose should be skipped, and the regular dosing schedule resumed. Patients should not take a double dose to make up for a missed one, as this may increase the risk of adverse effects. Maintenance of consistent antiplatelet effect is important, so patients should be counseled on strategies to improve adherence, such as using pill organizers or setting reminders. If multiple doses are missed, patients should contact their healthcare provider for guidance.

Overdose

Overdose may manifest as symptoms primarily related to the aspirin component, including tinnitus, hearing loss, hyperventilation, vertigo, sweating, nausea, vomiting, and metabolic acidosis. Severe overdose may lead to respiratory alkalosis, fever, hypoglycemia, hypokalemia, and seizures. Dipyridamole overdose may cause peripheral vasodilation with hypotension, tachycardia, and flushing. Management involves immediate medical attention, gastric lavage or activated charcoal if presentation is early, and supportive care including fluid replacement and correction of electrolyte imbalances. Hemodialysis may be considered for severe aspirin toxicity. Specific monitoring of coagulation parameters, acid-base status, and renal function is essential.

Storage

Store at controlled room temperature between 20°C to 25°C (68°F to 77°F), with excursions permitted between 15°C to 30°C (59°F to 86°F). Keep the container tightly closed and protect from moisture by keeping the desiccant in the bottle. Do not transfer capsules to other containers that lack moisture protection. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging. Properly dispose of any unused medication through medication take-back programs or according to local regulations.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Individual patient needs may vary, and healthcare decisions should be made in consultation with a qualified medical professional. The prescribing physician should be consulted for specific guidance regarding appropriate use, dosing, and monitoring. Actual clinical effects may differ from those described based on individual patient factors. Full prescribing information including boxed warnings should be reviewed before initiation of therapy.

Reviews

Clinical studies demonstrate that Aggrenox reduces the relative risk of recurrent stroke by approximately 22-37% compared to placebo and by 19% compared to aspirin alone, based on the ESPS-2 and ESPRIT trials. Many neurologists report positive experiences with the medication in appropriate patient populations, noting its efficacy in secondary prevention while acknowledging the need to manage initial side effects such as headache. Patient experiences vary, with some reporting excellent tolerance after the initial adjustment period, while others discontinue due to persistent headache or gastrointestinal effects. The combination therapy is generally regarded as a valuable option in the stroke prevention arsenal, particularly for patients who have experienced stroke despite aspirin monotherapy.