Aspirin + Clopidogrel

Aspirin + Clopidogrel is a dual antiplatelet therapy (dapt) medicine available in Bangladesh under many brand names. Below are its uses, side effects and precautions — and every brand with its current price.

• After coronary stent (ring) placement / PCI — to prevent stent thrombosis
• Acute coronary syndrome — unstable angina or heart attack (with or without stenting)
• After a heart attack — to reduce the risk of another cardiovascular event
• Selected high-risk patients — short-term use after certain minor strokes or TIAs, strictly under specialist supervision

Because both ingredients reduce clotting, bleeding is the main side effect — more than with either medicine alone:

• Easy bruising, longer bleeding from small cuts
• Nosebleeds, bleeding gums
• Stomach pain, heartburn, indigestion (mainly from aspirin)
• Diarrhoea, rash, itching

Seek urgent medical help if you notice:

• Black or tarry stools, vomiting blood or material like coffee grounds
• Blood in urine, unusually heavy menstrual bleeding
• Bleeding that does not stop with pressure
• Sudden severe headache, weakness of one side, or confusion (possible brain bleed)
• Wheezing or breathing difficulty after a dose (aspirin-sensitive asthma)

• Tell every doctor, dentist or surgeon that you take Aspirin + Clopidogrel before any operation, endoscopy or tooth extraction — timing of stopping and restarting is decided only by your cardiologist.
• Take after food and report any stomach pain early; your doctor may add a stomach-protecting medicine.
• Tell your doctor about any history of ulcer, gastrointestinal bleeding, asthma, gout, liver or kidney disease.
• Use a soft toothbrush, shave carefully, and avoid contact sports or work with high injury risk.
• Avoid alcohol — it multiplies the risk of stomach bleeding.
• Carry a card or note saying you are on dual antiplatelet therapy, especially in the first year after a stent.

• Anticoagulants (warfarin, rivaroxaban, heparin): major bleeding risk — "triple therapy" is used only briefly under strict specialist supervision
• NSAID painkillers (ibuprofen, diclofenac, naproxen): greatly increase stomach bleeding risk and ibuprofen can blunt aspirin's effect — use paracetamol instead for everyday pain
• Omeprazole/esomeprazole: may reduce the clopidogrel component's effect — pantoprazole or rabeprazole preferred for stomach protection
• SSRIs (escitalopram, sertraline) and corticosteroids: add to bleeding tendency
• Methotrexate: aspirin can raise its toxicity
• Gout medicines: aspirin can blunt their effect and raise uric acid

Tell your doctor about all medicines, supplements and herbal products (including fish oil, ginkgo) you use.

• Allergy to aspirin, other NSAIDs or clopidogrel
• Active bleeding — bleeding peptic ulcer, brain haemorrhage
• Aspirin-induced asthma or nasal polyps with asthma
• Severe liver disease
• Children and adolescents under 16 with viral illness (Reye's syndrome risk from aspirin)
• Third trimester of pregnancy

Pregnancy: This combination is generally avoided in pregnancy. Aspirin at full antiplatelet doses is contraindicated in the third trimester (risk of bleeding and premature closure of a heart vessel in the baby), and clopidogrel has limited human data. If you are pregnant or planning pregnancy, inform your cardiologist immediately so therapy can be adjusted.

Lactation: Small amounts of aspirin pass into breast milk and clopidogrel data are lacking, so breastfeeding during dual antiplatelet therapy is generally not recommended. Discuss the safest plan with your doctor.

Store below 30°C in a cool, dry place away from direct sunlight and moisture. Keep in the original blister pack until use — aspirin degrades in humid conditions. Keep out of the reach of children. Do not use after the expiry date or if tablets smell of vinegar.