Clogfree Plus
Generic Name
Clopidogrel + Aspirin (Acetylsalicylic Acid)
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| clogfree plus 75 mg tablet | ৳ 12.00 | ৳ 120.00 |
Description
Overview of the medicine
Clogfree Plus is a combination of Clopidogrel and Aspirin, used to prevent blood clots and reduce the risk of cardiovascular events like heart attack and stroke. Clopidogrel inhibits platelet aggregation by irreversibly binding to the P2Y12 receptor, while Aspirin inhibits thromboxane A2 production, further preventing platelet aggregation.
Uses & Indications
Dosage
Adults
Typically, one tablet (Clopidogrel 75 mg + Aspirin 75 mg) once daily. Dosage may vary based on clinical condition and physician's advice.
Elderly
No dose adjustment is generally required for elderly patients.
Renal_impairment
Caution advised. No dose adjustment for mild to moderate renal impairment, but use with caution in severe impairment as safety data are limited.
How to Take
Take orally, with or without food. Swallow the tablet whole with a glass of water. Do not crush or chew.
Mechanism of Action
Clopidogrel is a prodrug that is metabolized to its active form, which selectively and irreversibly inhibits the binding of adenosine diphosphate (ADP) to its P2Y12 receptor on platelets. This inhibition prevents platelet activation and aggregation. Aspirin, at low doses, irreversibly inhibits cyclooxygenase-1 (COX-1) in platelets, leading to reduced production of thromboxane A2, a potent inducer of platelet aggregation and vasoconstriction.
Pharmacokinetics
Onset
Clopidogrel: Antiplatelet effect seen within 2 hours, maximal effect within 3-7 days. Aspirin: Antiplatelet effect within 1 hour.
Excretion
Clopidogrel: ~50% in urine, ~48% in feces. Aspirin: Metabolites primarily excreted via urine.
Half life
Clopidogrel: ~6 hours for parent drug, ~30 minutes for active metabolite. Aspirin: ~2-3 hours for acetylsalicylic acid.
Absorption
Clopidogrel is rapidly absorbed from the GI tract (oral bioavailability approximately 50%). Aspirin is rapidly absorbed from the GI tract.
Metabolism
Clopidogrel is extensively metabolized in the liver, primarily by CYP2C19, to an active thiol metabolite and an inactive carboxylic acid derivative. Aspirin is rapidly hydrolyzed to salicylic acid in the GI tract, liver, and blood.
Side Effects
Contraindications
- Hypersensitivity to Clopidogrel, Aspirin, or any component of the formulation.
- Active pathological bleeding (e.g., peptic ulcer, intracranial hemorrhage).
- Severe hepatic impairment.
- Aspirin-induced asthma, urticaria, or other allergic reactions.
- Third trimester of pregnancy (due to Aspirin component).
Drug Interactions
Other NSAIDs
Increased risk of gastrointestinal bleeding. Concomitant use is generally not recommended.
Thrombolytics
Increased risk of bleeding. Concomitant use should be monitored closely.
SSRIs and SNRIs
Increased risk of bleeding due to their effects on platelet function. Use with caution.
Oral Anticoagulants (e.g., Warfarin)
Increased risk of bleeding. Concomitant use should be undertaken with caution and close monitoring.
Proton Pump Inhibitors (PPIs) (e.g., Omeprazole)
May reduce the antiplatelet effect of Clopidogrel by inhibiting CYP2C19. Use with caution; consider alternative PPIs or H2 blockers.
Storage
Store in a cool, dry place (below 30°C), away from direct sunlight and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include increased bleeding time, hemorrhagic complications, gastrointestinal irritation, tinnitus (with Aspirin). Management involves symptomatic and supportive care. Gastric lavage and activated charcoal may be considered if recent ingestion. Platelet transfusion may be considered for severe bleeding.
Pregnancy & Lactation
Pregnancy: Use is generally contraindicated, especially during the third trimester, due to the Aspirin component's risk of premature closure of the ductus arteriosus and other adverse effects. Lactation: Both clopidogrel and aspirin metabolites are excreted in breast milk. A decision should be made whether to discontinue nursing or the drug, taking into account the importance of the drug to the mother.
Side Effects
Contraindications
- Hypersensitivity to Clopidogrel, Aspirin, or any component of the formulation.
- Active pathological bleeding (e.g., peptic ulcer, intracranial hemorrhage).
- Severe hepatic impairment.
- Aspirin-induced asthma, urticaria, or other allergic reactions.
- Third trimester of pregnancy (due to Aspirin component).
Drug Interactions
Other NSAIDs
Increased risk of gastrointestinal bleeding. Concomitant use is generally not recommended.
Thrombolytics
Increased risk of bleeding. Concomitant use should be monitored closely.
SSRIs and SNRIs
Increased risk of bleeding due to their effects on platelet function. Use with caution.
Oral Anticoagulants (e.g., Warfarin)
Increased risk of bleeding. Concomitant use should be undertaken with caution and close monitoring.
Proton Pump Inhibitors (PPIs) (e.g., Omeprazole)
May reduce the antiplatelet effect of Clopidogrel by inhibiting CYP2C19. Use with caution; consider alternative PPIs or H2 blockers.
Storage
Store in a cool, dry place (below 30°C), away from direct sunlight and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include increased bleeding time, hemorrhagic complications, gastrointestinal irritation, tinnitus (with Aspirin). Management involves symptomatic and supportive care. Gastric lavage and activated charcoal may be considered if recent ingestion. Platelet transfusion may be considered for severe bleeding.
Pregnancy & Lactation
Pregnancy: Use is generally contraindicated, especially during the third trimester, due to the Aspirin component's risk of premature closure of the ductus arteriosus and other adverse effects. Lactation: Both clopidogrel and aspirin metabolites are excreted in breast milk. A decision should be made whether to discontinue nursing or the drug, taking into account the importance of the drug to the mother.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
24 to 36 months from manufacturing date
Availability
Available in all pharmacies and hospitals
Approval Status
Approved by DGDA
Patent Status
Generic available
WHO Essential Medicine
YesClinical Trials
Key trials like CURE, CREDO, COMMIT/CCS-2, and CURRENT-OASIS 7 have demonstrated the benefits of dual antiplatelet therapy (Clopidogrel + Aspirin) in reducing ischemic events in patients with acute coronary syndromes or after percutaneous coronary intervention.
Lab Monitoring
- Regular monitoring of complete blood count (CBC) including platelet count.
- Liver function tests (LFTs) especially in patients with hepatic impairment.
- Renal function tests (RFTs) for patients with renal impairment or at risk.
Doctor Notes
- Assess bleeding risk carefully before initiating and during therapy, especially in elderly patients or those with a history of GI bleeding.
- Consider CYP2C19 genotyping in patients with a history of recurrent thrombotic events while on clopidogrel, to identify poor metabolizers.
- Advise patients to inform all healthcare providers, including dentists, about Clopidogrel Plus use prior to any procedures.
Patient Guidelines
- Take the medicine exactly as prescribed by your doctor.
- Do not stop taking this medication without consulting your doctor, as it may increase your risk of a heart attack or stroke.
- Inform your doctor or dentist that you are taking this medication before any surgery or dental procedure.
- Report any unusual bleeding or bruising to your doctor immediately.
Missed Dose Advice
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.
Driving Precautions
Clogfree Plus is generally not expected to affect the ability to drive or operate machinery. However, if you experience dizziness or visual disturbances, avoid such activities.
Lifestyle Advice
- Maintain a healthy diet and regular exercise as advised by your doctor.
- Avoid smoking and limit alcohol consumption to reduce cardiovascular risk and bleeding risk.
- Inform your healthcare provider about all other medications, supplements, and herbal products you are taking.
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