Clognil-Plus
Generic Name
Clopidogrel 75 mg and Aspirin 75 mg Tablet
Manufacturer
Incepta Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| clognil plus 75 mg tablet | ৳ 12.04 | ৳ 120.40 |
Description
Overview of the medicine
Clognil-Plus 75 mg tablet is a combination antiplatelet medication containing Clopidogrel and Aspirin. It is primarily used to prevent blood clots in patients with cardiovascular diseases, thereby reducing the risk of heart attack and stroke.
Uses & Indications
Dosage
Adults
Typically one tablet (Clopidogrel 75 mg and Aspirin 75 mg) orally once daily. For acute coronary syndrome, a loading dose of Clopidogrel may be prescribed before maintenance therapy, as per physician's advice.
Elderly
No specific dosage adjustment is generally required, but close monitoring for bleeding risk is recommended.
Renal_impairment
Use with caution in patients with renal impairment. Dose adjustment may be necessary in severe impairment, and monitoring for adverse effects is crucial.
How to Take
Take orally, with or without food. Swallow the tablet whole; do not crush, chew, or break it. For optimal absorption and gastric protection, it is often recommended to take it with food.
Mechanism of Action
Clopidogrel selectively inhibits the binding of adenosine diphosphate (ADP) to its receptor on platelets, thereby preventing platelet activation and aggregation. Aspirin irreversibly inhibits cyclooxygenase-1 (COX-1) enzyme, which reduces the production of thromboxane A2 (TxA2), a potent inducer of platelet aggregation and vasoconstriction.
Pharmacokinetics
Onset
Clopidogrel: Within 2 hours (antiplatelet effect). Aspirin: Within minutes.
Excretion
Clopidogrel: Approximately 50% renally and 48% fecally. Aspirin: Primarily renal excretion of salicylic acid and its metabolites.
Half life
Clopidogrel: Active metabolite ~8 hours. Aspirin: Parent drug ~20 minutes, Salicylic acid 2-3 hours (dose-dependent).
Absorption
Clopidogrel is rapidly absorbed and is a prodrug requiring hepatic metabolism to its active form. Aspirin is rapidly and completely absorbed from the gastrointestinal tract.
Metabolism
Clopidogrel: Extensively metabolized in the liver by CYP450 enzymes (mainly CYP2C19, CYP3A4, CYP2B6, CYP1A2, CYP2C9) to its active and inactive metabolites. Aspirin: Hydrolyzed to salicylic acid in the gastrointestinal mucosa, liver, and red blood cells.
Side Effects
Contraindications
- Hypersensitivity to Clopidogrel, Aspirin, or any component of the tablet.
- Active pathological bleeding, such as peptic ulcer or intracranial hemorrhage.
- Severe hepatic impairment.
- Aspirin-induced asthma, urticaria, or other allergic-type reactions.
Drug Interactions
Corticosteroids
Increased risk of gastrointestinal bleeding.
Warfarin and other oral anticoagulants
Increased risk of bleeding.
Non-steroidal anti-inflammatory drugs (NSAIDs)
Increased risk of gastrointestinal bleeding.
Proton pump inhibitors (PPIs) (e.g., Omeprazole, Esomeprazole)
May reduce the antiplatelet effect of clopidogrel by inhibiting CYP2C19.
Selective serotonin reuptake inhibitors (SSRIs) / Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Increased risk of bleeding.
Storage
Store in a cool, dry place below 30°C. Protect from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include prolonged bleeding time, gastrointestinal bleeding, tinnitus (ringing in the ears), dizziness, headache, and confusion. Management involves supportive care, gastric lavage, activated charcoal, and in severe bleeding, platelet transfusion. Closely monitor coagulation parameters.
Pregnancy & Lactation
Clopidogrel: Pregnancy Category B; Aspirin: Pregnancy Category D (especially in 3rd trimester). Not recommended during pregnancy, particularly in the third trimester, due to potential risks to the fetus (e.g., premature closure of ductus arteriosus). Avoid during lactation as both components are excreted in breast milk and may pose risks to the infant (e.g., bleeding risk for clopidogrel, Reye's syndrome for aspirin).
Side Effects
Contraindications
- Hypersensitivity to Clopidogrel, Aspirin, or any component of the tablet.
- Active pathological bleeding, such as peptic ulcer or intracranial hemorrhage.
- Severe hepatic impairment.
- Aspirin-induced asthma, urticaria, or other allergic-type reactions.
Drug Interactions
Corticosteroids
Increased risk of gastrointestinal bleeding.
Warfarin and other oral anticoagulants
Increased risk of bleeding.
Non-steroidal anti-inflammatory drugs (NSAIDs)
Increased risk of gastrointestinal bleeding.
Proton pump inhibitors (PPIs) (e.g., Omeprazole, Esomeprazole)
May reduce the antiplatelet effect of clopidogrel by inhibiting CYP2C19.
Selective serotonin reuptake inhibitors (SSRIs) / Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Increased risk of bleeding.
Storage
Store in a cool, dry place below 30°C. Protect from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include prolonged bleeding time, gastrointestinal bleeding, tinnitus (ringing in the ears), dizziness, headache, and confusion. Management involves supportive care, gastric lavage, activated charcoal, and in severe bleeding, platelet transfusion. Closely monitor coagulation parameters.
Pregnancy & Lactation
Clopidogrel: Pregnancy Category B; Aspirin: Pregnancy Category D (especially in 3rd trimester). Not recommended during pregnancy, particularly in the third trimester, due to potential risks to the fetus (e.g., premature closure of ductus arteriosus). Avoid during lactation as both components are excreted in breast milk and may pose risks to the infant (e.g., bleeding risk for clopidogrel, Reye's syndrome for aspirin).
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
24 to 36 months from manufacturing date.
Availability
Pharmacies, hospitals
Approval Status
Approved by regulatory authorities
Patent Status
Generic available
WHO Essential Medicine
YesClinical Trials
Extensive clinical trials (e.g., CURE, CREDO, COMMIT/CCS-2, CLARITY-TIMI 28) have demonstrated the efficacy and safety of clopidogrel and aspirin combination in reducing cardiovascular events in various patient populations.
Lab Monitoring
- Complete Blood Count (CBC) with platelet count and hemoglobin (due to bleeding risk).
- Liver function tests (LFTs) periodically, especially in patients with pre-existing hepatic impairment.
- Renal function tests (RFTs) periodically.
Doctor Notes
- Carefully assess the patient's bleeding risk before initiating and during therapy, especially in elderly patients, those with a history of GI bleeding, or those on concomitant medications that increase bleeding risk.
- Educate patients on the importance of adherence, recognizing signs of bleeding, and informing all healthcare providers about this medication.
Patient Guidelines
- Take this medication exactly as prescribed by your doctor. Do not stop taking it without consulting your doctor, even if you feel well, as stopping abruptly can increase your risk of heart attack or stroke.
- Report any unusual bleeding or bruising, black or tarry stools, or persistent stomach pain to your doctor immediately.
- Inform all your healthcare providers, including dentists and pharmacists, that you are taking this medication before any surgery, dental procedure, or new medication.
Missed Dose Advice
If you miss a dose, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one.
Driving Precautions
Clognil-Plus 75 mg tablet generally does not impair the ability to drive or operate machinery. However, if you experience dizziness or visual disturbances, avoid driving or operating heavy machinery.
Lifestyle Advice
- Avoid or limit alcohol consumption as it can increase the risk of gastrointestinal bleeding.
- Maintain a healthy lifestyle, including a balanced diet, regular exercise, and smoking cessation, to support cardiovascular health.
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