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 more effectively than either component alone. This combination therapy represents a well-established, evidence-based approach to reducing the risk of recurrent cerebrovascular events by targeting multiple pathways of thrombus formation. Its use is supported by major international stroke guidelines, making it a cornerstone in neurological and cardiovascular protective pharmacotherapy.

Features

• Contains a fixed-dose combination of 200 mg extended-release dipyridamole and 25 mg aspirin
• Specifically formulated for twice-daily dosing to maintain consistent antiplatelet effect
• Extended-release dipyridamole component provides sustained plasma concentrations
• Enteric-coated aspirin component helps protect gastric mucosa
• Available in capsule form for oral administration
• Manufactured under strict pharmaceutical quality control standards

Benefits

• Significantly reduces the relative risk of recurrent stroke compared to aspirin alone
• Provides dual-mechanism antiplatelet protection through complementary pathways
• Offers convenient twice-daily dosing regimen for improved adherence
• Backed by extensive clinical trial evidence including the landmark ESPS-2 study
• May be appropriate for patients who have experienced stroke while on aspirin monotherapy
• Provides comprehensive anti-thrombotic protection with a single medication

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 not indicated for initial stroke prevention in patients without prior cerebrovascular events. The medication is commonly prescribed by neurologists, cardiologists, and vascular specialists as part of a comprehensive secondary prevention strategy that may also include blood pressure management, cholesterol control, and lifestyle modifications. Clinical decision-making typically involves assessing the patient’s bleeding risk versus the benefit of enhanced antiplatelet protection.

Dosage and direction

The recommended 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 chewed or crushed. Administration with food may help minimize potential gastrointestinal discomfort. The medication is typically taken in the morning and evening, maintaining consistent timing to ensure stable antiplatelet effects. Treatment is usually long-term unless significant adverse effects or contraindications develop. Dosage adjustment is not typically required for elderly patients, but careful monitoring is advised.

Precautions

Patients should be carefully evaluated for bleeding risk before initiating therapy. Regular monitoring of complete blood count is recommended, especially during the first few months of treatment. Caution is advised in patients with hepatic impairment, renal impairment, or history of peptic ulcer disease. The medication may cause dizziness; patients should be cautioned about operating machinery or driving until they know how the medication affects them. Alcohol consumption should be limited due to increased risk of gastrointestinal bleeding. Patients scheduled for surgical procedures should inform their surgeon about Aggrenox use, as temporary discontinuation may be necessary.

Contraindications

Hypersensitivity to aspirin, dipyridamole, or any component of the formulation. Patients with known aspirin-sensitive asthma. Active pathological bleeding such as peptic ulcer disease or intracranial hemorrhage. Severe hepatic impairment. Combination with other anticoagulants unless specifically indicated and carefully monitored. Patients with severe renal failure (creatinine clearance <30 mL/min). History of aspirin-associated asthma or urticaria. Third trimester of pregnancy.

Possible side effects

Common side effects may include headache (often dose-related and typically diminishing with continued use), gastrointestinal discomfort, nausea, diarrhea, and vomiting. Less frequently, patients may experience dizziness, abdominal pain, or bleeding manifestations such as easy bruising. Serious but rare side effects include severe bleeding events, hypersensitivity reactions, hepatitis, and tinnitus. The incidence of headache tends to decrease with continued therapy, often within the first week of treatment. Gastrointestinal side effects may be mitigated by taking with food.

Drug interaction

Concomitant use with other antiplatelet agents, NSAIDs, or anticoagulants increases bleeding risk. ACE inhibitors may have diminished antihypertensive effect when combined with aspirin. Dipyridamole may counteract the effects of cholinesterase inhibitors. Aspirin may increase serum concentrations of methotrexate, phenytoin, and valproic acid. May enhance effects of hypoglycemic agents. Concomitant use with other medications affecting platelet function requires careful monitoring. 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 dose. Maintaining consistent antiplatelet coverage is important, so patients should be educated about adherence strategies. If multiple doses are missed, medical advice should be sought regarding appropriate restarting of therapy.

Overdose

Symptoms of overdose may include ringing in the ears, hearing loss, dizziness, nausea, vomiting, sweating, warm sensations, restlessness, and signs of bleeding. Severe overdose may lead to metabolic acidosis, hyperthermia, hypoglycemia, convulsions, coma, and cardiovascular collapse. Management is supportive and symptomatic, with particular attention to maintaining adequate renal function and correcting electrolyte imbalances. Gastric lavage and activated charcoal may be considered if presentation is early. There is no specific antidote; treatment should focus on supporting vital functions and managing bleeding complications.

Storage

Store at room temperature between 15-30°C (59-86°F). Keep in the original container with the lid tightly closed to protect from moisture. Do not store in bathroom cabinets where humidity levels may fluctuate. Keep out of reach of children and pets. Do not use if capsules appear damaged or discolored. Protect from excessive heat and light. Do not transfer capsules to other containers unless using a certified pill organizer designed for moisture protection.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Treatment decisions should be made in consultation with a qualified healthcare professional based on individual patient circumstances. The prescribing physician should be consulted for complete information regarding indications, contraindications, warnings, precautions, and adverse effects. Patients should not discontinue or modify treatment without medical supervision.

Reviews

Clinical studies have demonstrated that Aggrenox reduces the relative risk of recurrent stroke by approximately 22-37% compared to aspirin alone, with number needed to treat of approximately 30-40 to prevent one stroke over two years. The European Stroke Prevention Study 2 (ESPS-2) established its efficacy with over 6,600 patient-years of follow-up. Real-world evidence supports its effectiveness in diverse patient populations, though individual responses may vary. Many clinicians report satisfactory outcomes with appropriate patient selection and monitoring. The combination therapy is generally well-tolerated, with headache being the most frequently reported side effect that often resolves with continued use.