Clogfree-Plus
Generic Name
Clopidogrel + Aspirin
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 75 mg Tablet is a combination of two antiplatelet medicines: Clopidogrel and Aspirin. It is used to prevent blood clots in the heart, brain, and blood vessels. This helps to reduce the risk of heart attack, stroke, and other serious cardiovascular events.
Uses & Indications
Dosage
Adults
Usually 1 tablet once daily, with or without food, as directed by a physician. In acute coronary syndrome, a loading dose of Clopidogrel may be prescribed (e.g., 300 mg or 600 mg) before initiating maintenance therapy.
Elderly
No specific dose adjustment is generally required for elderly patients, but caution should be exercised due to increased risk of bleeding.
Renal_impairment
No dose adjustment needed for mild to moderate renal impairment. Use with caution in severe renal impairment, monitor for adverse effects.
How to Take
Take the tablet whole with a glass of water, with or without food. Do not crush, chew, or break the tablet. It is important to take the medicine regularly at the same time each day.
Mechanism of Action
Clopidogrel is an antiplatelet medication. It works by preventing platelets from sticking together and forming harmful blood clots. Aspirin is a non-steroidal anti-inflammatory drug (NSAID) with antiplatelet properties. It irreversibly inhibits cyclooxygenase-1 (COX-1), preventing the formation of thromboxane A2, a potent platelet aggregator. Together, they work synergistically to reduce the risk of clot formation.
Pharmacokinetics
Onset
Clopidogrel: Antiplatelet effect seen within 2 hours, full effect within 3-7 days. Aspirin: Platelet inhibition within 30 minutes.
Excretion
Clopidogrel: Approximately 50% renally and 48% fecally as metabolites. Aspirin/Salicylic acid: Primarily renally excreted.
Half life
Clopidogrel (parent drug): Approximately 6 hours. Active metabolite: Approximately 30 minutes. Aspirin: 15-20 minutes. Salicylic acid (metabolite): 2-3 hours (low dose).
Absorption
Clopidogrel is rapidly absorbed from the GI tract after oral administration, but extensively metabolized to an inactive carboxylic acid derivative and an active thiol metabolite. Aspirin is rapidly and completely absorbed from the GI tract after oral administration.
Metabolism
Clopidogrel is a prodrug, metabolized in the liver by cytochrome P450 enzymes (mainly CYP2C19, CYP1A2, CYP2B6, CYP3A4) to its active metabolite. Aspirin is rapidly hydrolyzed to salicylic acid in the gastrointestinal tract and liver.
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 is contraindicated in patients with asthma, rhinitis, and nasal polyps.
Drug Interactions
NSAIDs (e.g., Ibuprofen, Naproxen)
Increased risk of gastrointestinal bleeding.
SSRIs (e.g., Fluoxetine, Sertraline)
Increased risk of bleeding, especially GI bleeding.
Warfarin and other oral anticoagulants
Significantly increased risk of bleeding; close monitoring required.
Other antiplatelet agents (e.g., Prasugrel, Ticagrelor)
Increased risk of bleeding.
Proton Pump Inhibitors (PPIs, e.g., Omeprazole, Esomeprazole)
May reduce the antiplatelet effect of Clopidogrel by inhibiting CYP2C19. Consider alternative PPIs (e.g., Pantoprazole) or H2 blockers.
Storage
Store in a cool and dry place, away from direct sunlight and moisture. Keep out of reach of children. Do not store above 30°C.
Overdose
Symptoms of overdose include increased bleeding (e.g., nosebleeds, bruising, gastrointestinal bleeding), tinnitus, hearing loss, confusion, and hyperventilation. Management involves supportive care, gastric lavage, activated charcoal, and if necessary, platelet transfusion for severe bleeding. Correction of fluid and electrolyte imbalances may be required.
Pregnancy & Lactation
Pregnancy: Use is generally not recommended in pregnancy, especially during the third trimester, due to the risk of fetal and maternal bleeding, and premature closure of the ductus arteriosus (due to Aspirin). Consult your doctor. Lactation: Both Clopidogrel and Aspirin (metabolites) are excreted in breast milk. A decision should be made whether to discontinue nursing or discontinue 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 is contraindicated in patients with asthma, rhinitis, and nasal polyps.
Drug Interactions
NSAIDs (e.g., Ibuprofen, Naproxen)
Increased risk of gastrointestinal bleeding.
SSRIs (e.g., Fluoxetine, Sertraline)
Increased risk of bleeding, especially GI bleeding.
Warfarin and other oral anticoagulants
Significantly increased risk of bleeding; close monitoring required.
Other antiplatelet agents (e.g., Prasugrel, Ticagrelor)
Increased risk of bleeding.
Proton Pump Inhibitors (PPIs, e.g., Omeprazole, Esomeprazole)
May reduce the antiplatelet effect of Clopidogrel by inhibiting CYP2C19. Consider alternative PPIs (e.g., Pantoprazole) or H2 blockers.
Storage
Store in a cool and dry place, away from direct sunlight and moisture. Keep out of reach of children. Do not store above 30°C.
Overdose
Symptoms of overdose include increased bleeding (e.g., nosebleeds, bruising, gastrointestinal bleeding), tinnitus, hearing loss, confusion, and hyperventilation. Management involves supportive care, gastric lavage, activated charcoal, and if necessary, platelet transfusion for severe bleeding. Correction of fluid and electrolyte imbalances may be required.
Pregnancy & Lactation
Pregnancy: Use is generally not recommended in pregnancy, especially during the third trimester, due to the risk of fetal and maternal bleeding, and premature closure of the ductus arteriosus (due to Aspirin). Consult your doctor. Lactation: Both Clopidogrel and Aspirin (metabolites) are excreted in breast milk. A decision should be made whether to discontinue nursing or discontinue 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
Typically 24-36 months from the date of manufacture when stored under recommended conditions.
Availability
Available in pharmacies, hospitals and clinics nationwide
Approval Status
Approved by DGDA, Bangladesh (Combination drugs are widely approved globally)
Patent Status
Off-patent (for generic components)
WHO Essential Medicine
YesClinical Trials
The efficacy and safety of Clopidogrel and Aspirin combination have been established through extensive clinical trials such as CURE, CREDO, and CHARISMA, which demonstrated significant reductions in the risk of cardiovascular events in various patient populations.
Lab Monitoring
- Regular monitoring of complete blood count (CBC) to check for anemia or thrombocytopenia.
- Monitoring for signs of bleeding or bruising.
- Liver function tests (LFTs) periodically, especially in patients with pre-existing hepatic impairment.
- Renal function tests, particularly in elderly patients or those with kidney disease.
Doctor Notes
- Assess patient's bleeding risk profile carefully before initiating therapy and throughout treatment.
- Consider genetic testing for CYP2C19 status in patients for whom Clopidogrel effectiveness is a concern (e.g., recurrent ischemic events on therapy).
- Counsel patients on signs of bleeding and the importance of adherence to therapy, especially following PCI or ACS.
Patient Guidelines
- Take this medicine exactly as prescribed by your doctor. Do not stop taking it without consulting your doctor, even if you feel well, as stopping prematurely can increase your risk of heart attack or stroke.
- Inform your doctor or dentist about taking Clogfree-Plus before any surgery or dental procedure, as it increases the risk of bleeding.
- Report any unusual bleeding or bruising immediately to your doctor.
- Avoid taking other NSAIDs (e.g., Ibuprofen, Naproxen) concurrently without consulting your doctor, as this may increase the risk of bleeding.
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 resume your regular dosing schedule. Do not take a double dose to make up for a missed one.
Driving Precautions
Clogfree-Plus is not expected to impair the ability to drive or operate machinery. However, if you experience dizziness or other side effects that could affect concentration, avoid driving or operating heavy machinery until you feel well.
Lifestyle Advice
- Maintain a healthy lifestyle, including a balanced diet low in saturated fats and cholesterol.
- Engage in regular physical activity as advised by your doctor.
- Quit smoking, as smoking significantly increases cardiovascular risk.
- Manage underlying conditions such as high blood pressure and diabetes.
- Limit alcohol consumption.
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