Dogrel Plus
Generic Name
Clopidogrel 75 mg + Aspirin 75 mg
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| dogrel plus 75 mg tablet | ৳ 12.00 | ৳ 120.00 |
Description
Overview of the medicine
Dogrel Plus 75 mg Tablet is a combination medicine containing Clopidogrel and Aspirin, primarily used to prevent blood clots in patients with cardiovascular conditions. It works by inhibiting platelet aggregation, thereby reducing the risk of heart attacks and strokes.
Uses & Indications
Dosage
Adults
Generally, one tablet (Clopidogrel 75 mg + Aspirin 75 mg) once daily, as prescribed by a physician. In acute coronary syndrome (ACS), loading dose may be higher for clopidogrel component.
Elderly
No dose adjustment is generally required for elderly patients, but caution is advised due to increased risk of bleeding.
Renal_impairment
No dose adjustment is necessary for patients with mild to moderate renal impairment. Use with caution in severe renal impairment.
How to Take
Take the tablet orally, with or without food. Swallow the tablet whole with water. Do not crush or chew.
Mechanism of Action
Clopidogrel is a prodrug that is metabolized to an active thiol metabolite. This active metabolite irreversibly binds to the P2Y12 adenosine diphosphate (ADP) receptor on platelets, thereby preventing ADP-mediated platelet activation and aggregation. Aspirin (acetylsalicylic acid) irreversibly inhibits cyclooxygenase-1 (COX-1) in platelets, which results in reduced synthesis of thromboxane A2 (TXA2). TXA2 is a potent inducer of platelet aggregation and vasoconstriction. Together, they provide synergistic antiplatelet activity.
Pharmacokinetics
Onset
Antiplatelet effects begin within 2 hours for clopidogrel (full effect 3-7 days) and within 1 hour for aspirin.
Excretion
Clopidogrel: Approximately 50% renally and 46% fecally. Aspirin/Salicylates: Primarily renally.
Half life
Clopidogrel: Parent drug ~6 hours; active metabolite ~30 minutes. Aspirin: Parent drug 15-20 minutes; salicylate ~2-3 hours (at low doses).
Absorption
Clopidogrel is rapidly absorbed after oral administration, with peak plasma concentrations occurring approximately 45 minutes after dosing. Aspirin is rapidly and completely absorbed from the gastrointestinal tract, primarily from the stomach and upper small intestine.
Metabolism
Clopidogrel is a prodrug extensively metabolized in the liver by cytochrome P450 enzymes (primarily CYP2C19) to its active metabolite and inactive carboxyl derivatives. Aspirin is rapidly hydrolyzed to salicylic acid in the gastrointestinal tract, liver, and blood, then further metabolized in the liver.
Side Effects
Contraindications
- Hypersensitivity to the active substances or to any of the excipients.
- Active pathological bleeding such as peptic ulcer or intracranial haemorrhage.
- Severe hepatic impairment.
- Severe renal impairment (for aspirin component in high doses).
- Concomitant use with strong CYP2C19 inhibitors.
- Asthma, rhinitis, or urticaria associated with aspirin or other NSAIDs.
Drug Interactions
Opioids
Delayed and reduced absorption of clopidogrel.
SSRIs/SNRIs
Increased risk of bleeding.
NSAIDs (e.g., Ibuprofen, Naproxen)
Increased risk of gastrointestinal bleeding.
Oral Anticoagulants (e.g., Warfarin)
Increased risk of bleeding due to additive antiplatelet/anticoagulant effects.
Other Antiplatelet agents (e.g., Ticagrelor)
Increased risk of bleeding.
Proton Pump Inhibitors (PPIs) (e.g., Omeprazole, Esomeprazole)
Some PPIs (especially Omeprazole, Esomeprazole) may reduce the antiplatelet effect of clopidogrel by inhibiting CYP2C19. Consider alternative PPIs (e.g., Pantoprazole) or H2 blockers.
Storage
Store below 30°C in a dry place, away 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), hearing loss, headache, dizziness, nausea, vomiting, confusion, and hyperventilation. Management involves symptomatic and supportive care. Gastric lavage may be considered soon after ingestion. Platelet transfusions may be necessary for severe bleeding. Hemodialysis can remove salicylates from the blood.
Pregnancy & Lactation
Pregnancy: Use of Clopidogrel + Aspirin during pregnancy is generally not recommended, especially in the third trimester due to the risk of premature closure of the ductus arteriosus and increased bleeding risk for the mother and fetus. Consult a physician. Lactation: Both clopidogrel metabolites and aspirin/salicylates are excreted in human milk. A decision should be made whether to discontinue nursing or to 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
24 months from manufacturing date
Availability
Available in pharmacies nationwide
Approval Status
Approved by regulatory authorities in Bangladesh (DGDA)
Patent Status
Generic available, patents expired for individual components
WHO Essential Medicine
YesClinical Trials
Numerous large-scale clinical trials (e.g., CURE, CREDO, COMMIT/CCS-2, PLATO for Clopidogrel alone or in combination with aspirin) have established the efficacy and safety of clopidogrel and aspirin combination in various atherothrombotic conditions. These trials demonstrated a significant reduction in cardiovascular events like MI, stroke, and cardiovascular death.
Lab Monitoring
- Monitor for signs of bleeding (e.g., hemoglobin, hematocrit).
- Monitor platelet function tests (e.g., PFA-100, light transmission aggregometry) if clopidogrel resistance is suspected.
- Regular liver function tests in patients with hepatic impairment.
Doctor Notes
- Emphasize the importance of adherence to therapy, especially post-PCI.
- Educate patients on bleeding symptoms and when to seek immediate medical attention.
- Consider PPI co-prescription for patients at high GI bleeding risk, choosing PPIs with minimal CYP2C19 interaction (e.g., pantoprazole).
- Counsel on potential drug interactions, particularly with NSAIDs and other anticoagulants.
Patient Guidelines
- Take the medicine exactly as prescribed by your doctor.
- Do not stop taking the medicine without consulting your doctor, as this may increase your risk of heart attack or stroke.
- Inform your doctor or dentist about taking this medicine 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 with your regular dosing schedule. Do not take a double dose to make up for a missed one.
Driving Precautions
Dogrel Plus 75 mg Tablet is not expected to affect the ability to drive or operate machinery. However, if you experience dizziness, avoid driving or operating heavy machinery.
Lifestyle Advice
- Maintain a healthy diet and regular exercise.
- Avoid smoking and excessive alcohol consumption.
- Manage blood pressure and cholesterol levels.
- Regular follow-up with your doctor.
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