Aggreno

Introduction
Aggreno is a combination of two medicines that mainly prevent clot formation in the blood vessels. It also helps to prevent another stroke in patients with a history of previous stroke or mini-stroke (transient ischaemic attack). Aggreno should be taken with food regularly at a fixed time each day. You should take it regularly at evenly spaced intervals as per the schedule prescribed by your doctor. Taking it at the same time every day will help you remember to take it. The dose and duration of treatment will depend on what you are being treated for. Do not stop taking it until you have finished the complete course, even when you feel better. Lifestyle changes like low-fat diet, exercise and not smoking may help this medicine to work better. Diarrhea, indigestion, and vomiting are some common side effects of this medicine. This medicine increases your risk of bleeding, so it is important to be careful while shaving, cutting nails and using sharp objects. Usually, it is advisable to avoid alcohol intake while taking this medicine. Before taking this medicine, tell your doctor if you have any liver or kidney disease. You must tell your doctor if you are pregnant, planning pregnancy or breastfeeding. You should also let your healthcare team know all other medicines you are taking as they may affect, or be affected by this medicine.

_
Uses of Aggreno
Blood clots
Side effects of Aggreno
Common
Increased bleeding tendency
Diarrhea
Indigestion
Vomiting
Headache
How to use Aggreno
Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Aggreno is to be taken with food.
How Aggreno works
Aggreno is a combination of two antiplatelet medicines: Aspirin and Dipyridamole which prevent stroke following an initial first stroke (transient ischaemic attack). It works by preventing platelets from sticking together which decreases the formation of harmful blood clots.
Quick Tips
You have been prescribed Arreno Capsule ER for preventing blood clots that cause a stroke.
It can be taken with or without food.
Arreno Capsule ER increases your risk of bleeding. Be careful while shaving, cutting fingernails or toenails, using sharp objects or engaging in contact sports (e.g. football, wrestling).
Notify your doctor if you experience stomach pain, nausea or vomiting that doesn’t go away.
Notify your doctor if you see blood in your vomit, urine or stool (black, tarry stools or bright red blood).
Brief Description
Indication
Secondary prophylaxis of transient ischemic attack (TIA), cerebrovascular accident (CVA)
Administration
May be taken with or without food. Swallow whole, do not chew/crush.
Adult Dose
Stroke Secondary prophylaxis of transient ischemic attack (TIA) or cerebrovascular accident (CVA) Adult: 1 capsule bid Hepatic impairment: Avoid in severe impairment.

_
Renal Dose
Renal impairment: CrCl (ml/min) <10: Avoid. _ Contraindication Hypersensitivity, allergy to NSAIDs. Bleeding disorders (factor VII or IX deficiencies). Patients with asthma, rhinitis or nasal polyps. Children <16 yr with viral infections. _ Mode of Action Aspirin inhibits platelet aggregation by irreversible inhibition of platelet cyclooxygenase and thus the formation of thromboxane A2 in the platelets. Dipyridamole inhibits platelet aggregation by preventing the uptake of adenosine into platelets, endothelial cells and RBCs. The combination results in additive antiplatelet effects. _ Precaution Unstable angina, recent MI, subaortic stenosis, severe coronary artery disease, hypotension, history of peptic ulcer disease. Monitor for signs of ulceration or bleeding, even in the absence of previous GI symptoms. Patients with inherited or acquired bleeding disorders. Admin of dipyridamole may cause increase in hepatic enzymes and hepatic failure. Avoid aspirin in patients with severe renal failure (CrCl <10 mL/minute). Discontinue if tinnitus or impaired hearing occurs. Dose of aspirin in this preparation is insufficient to prevent MI. Pregnancy, lactation. Lactation: Drug enters breast milk; use with caution _ Side Effect >10% Headache (10-39%),Dyspepsia (4-18%),Abdominal pain (4-18%),Nausea (6-16%),Diarrhea (13%) 1-10% Vomiting (3-8%),Pain (6%),Fatigue (6%),Arthralgia (5%),Back pain (5%),Hemorrhage, nonspecific (3%),Accidental injury (3%),Epistaxis (3%),Amnesia (3%),Arthritis (2%),Melena (2%),Asthenia (2%),Convulsions (2%),Neoplasm, nonspecific (2%),Anemia (2%),Rectal hemorrhage (2%),Malaise (2%),Cardiac failure (2%),Coughing (2%),Purpura (1%),GI hemorrhage (1%),Anorexia (1%),Somnolence (1%) ,Myalgia (1%),Arthrosis (1%),Confusion (1%),Hemorrhoids (1%),Syncope (1%),Upper respiratory tract infection (1%)

_
Pregnancy Category Note
Pregnancy Available data from published studies and postmarketing experience with use during pregnancy have not identified clear association between drug use and major birth defects, miscarriage, or adverse maternal or fetal outcomes drug combination contains low-dose aspirin which is an NSAID Increases risk for bleeding; maternal use of high-dose aspirin can result in excessive blood loss at delivery, prolonged gestation, prolonged labor, intracranial hemorrhage in premature infants, low birth weight, stillbirth, and neonatal death Lactation Based on data from a clinical lactation study in breastfeeding women taking low-dose aspirin, the metabolite salicylic acid is present in human milk in low levels; dipyridamole is also present in human milk; there is no information on the effects of drug combination components on breastfed infant or on milk production; there is insufficient information to determine effects of aspirin on breastfed infant and no information on effects of aspirin on milk production; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed child from therapy or from underlying maternal condition

_
Interaction
Aspirin: May reduce hypotensive and hyponatraemic effects of ACE inhibitors; may increase serum levels and toxicity of acetazolamide; increases anticoagulant effect of heparin, thus increasing bleeding risk; may reduce hypotensive effect of β-blockers; may reduce efficacy of diuretics in patients with underlying renal or CV disease; salicylate may inhibit renal clearance of methotrexate, thus increasing the risk of bone marrow toxicity; increased risk of bleeding or reduced renal function when used with NSAIDs; increased risk of hypoglycaemia when used with oral hypoglycaemic drugs; salicylate antagonises the uricosuric effect of uricosuric agents; may increase adverse effect of alendronate. Dipyridamole: May antagonise the anticholinesterase effect of cholinesterase inhibitors. Increased risk of bleeding when used with warfarin. Antiplatelet effect of aspirin may be increased by antidepressants e.g. TCAs, selective serotonin reuptake inhibitors. Potentially Fatal: Salicylates may increase adverse effect of drotrecogin alfa. Dypyridamole may increase plasma levels and CV effects of adenosine. Ketorolac may enhance adverse effect of aspirin. Dipyridamole may increase therapeutic effect of regadenoson. Salicylates may increase the anticoagulant effect of vit K antagonists. Salicylates may increase the adverse effect of varicella virus-containing vaccines.

_