Агренокс®

General characteristics. Structure:

Active ingredient: 25 mg of acetylsalicylic acid in the form of a tablet, 200 mg of Dipiridamolum in the form of a pellet (in 1 capsule).

Tablet excipients: lactoses monohydrate, cellulose microcrystallic, the starch which corn is dried up silicon dioxide colloid, aluminum stearate, sucrose, acacias gum, titanium dioxide, talc.

Pellet excipients: tartaric acid (spherical), tartaric acid (powder), povidone (Kollidon 25), copolymer of methacrylic acid and methylmethacrylate, a gipromelloza HP 55 phthalate, a gipromelloz, a glitserol triacetate (Triacetin), диметикон 350, stearic acid, talc, the Arabian gum, water purified (disappears), isopropanol (disappears), ethanol of 96% (disappears).

Structure of a cover of the capsule: gelatin, titanium dioxide, ferrous oxide yellow (dye), ferrous oxide red (dye).

Pharmacological properties:

Pharmacodynamics. Antiagregantny action of a combination of ASK and Dipiridamolum is caused by various biochemical mechanisms.

ASK inactivates TsOG enzyme in thrombocytes, prevents formation of A2 thromboxane - the powerful inductor of aggregation of thrombocytes and vasoconstriction.

Dipiridamolum inhibits capture of adenosine in erythrocytes, thrombocytes and endothelial cells. The inhibition reaches 80%, in therapeutic concentration (0.5-2 mkg/ml) is dozozavisimy. Increase in concentration of adenosine which acts on A2 receptors of thrombocytes is result of inhibition, stimulating adenylatecyclase of thrombocytes, thus increasing concentration of tsAMF of thrombocytes. Dipiridamolum inhibits FDE in various fabrics. Therapeutic concentration of Dipiridamolum with the participation of nitrogen oxide (NO - the endothelial running-down factor) inhibit tsGMF-FDE, thus increase tsGMF.

Adenosine does not render vasodilating effect that is one of mechanisms thanks to which Dipiridamolum causes vasodilatation. Dipiridamolum stimulates biosynthesis and release of prostacyclin with an endothelium of vessels, reduces a trombogenicity of subendothelial structures, increasing concentration of a protective mediator of 13-hydroxyoctadecadienoic acid. Various stimulators (including collagen, ADF) suppress aggregation of thrombocytes. Reduction of aggregation of thrombocytes leads to normalization of consumption of adenosine thrombocytes.

ASK inhibits only aggregation of thrombocytes, Dipiridamolum in addition slows down activation and adhesion of thrombocytes. At a combination of these HP the additive effect is shown

Indications to use:

Secondary prevention of the ischemic stroke proceeding as thrombosis and the tranzitorny ischemic attacks.

Route of administration and doses:

Inside, irrespective of meal, without chewing, washing down with 1 glass of water, on 1 capsule (25 mg of ACK+200 of mg of Dipiridamolum) 2 times a day.

Features of use:

The patients receiving Dipiridamolum inside in need of carrying out a pharmacological stress test with in/in introduction of Dipiridamolum, have to stop administration of drug for 24 h before test (for obtaining reliable result).

After change of a dose of Dipiridamolum, correction of the main therapy can be required by patients with a malignant myasthenia.

At patients of senile age with the accompanying ascending cholangitis and receiving Dipiridamolum for many years, not conjugated Dipiridamolum as a part of gallstones (70% of dry weight of a stone) can be found. Presence of Dipiridamolum at gallstones can be explained with a bacterial deglyukuronirovaniye of the conjugated Dipiridamolum in bile.

Side effects:

Allergic reactions: rash, urticaria, bronchospasm, Quincke's disease.

From integuments: bruises, ecchymomas, hematomas.

Laboratory indicators: thrombocytopenia.

Dipiridamolum (in addition): dizziness, migrenepodobny headache, nausea, vomiting; tachycardia, decrease in the ABP, "inflows", manifestation of symptoms of an ischemic heart disease; diarrhea, mialgiya.

ASK (in addition): nausea, vomiting, pain in epigastric area, erosive gastritis, stomach ulcer, an ulcer of a 12-perstny gut, gastrointestinal bleeding; hypocoagulation, anemia.

Interaction with other medicines:

ASK strengthens effect of anticoagulants (derivative coumarin, heparin), drugs of the thrombocytes which are slowing down aggregation (klopidogret, тиклопидин), valproic acid; strengthens effect of hypoglycemic HP, toxicity of a methotrexate; reduces natriuretic effect of Spironolactonum, inhibits effect of uricosuric HP (a probenetsid, Sulfinpyrazonum); increases risk of side effects from a GIT at simultaneous use with NPVP, GKS, ethanol. The concomitant use of an ibuprofen and ASK, at patients with the increased risk of the CCC diseases, reduces positive effect of ASK on CCC.

Dipiridamolum increases concentration of adenosine in plasma, strengthening its cardiovascular effects. It is necessary to adjust an adenosine dose.

Dipiridamolum is not changed by the frequency and weight of bleedings against the background of warfarin reception.

Dipiridamolum strengthens action of gipotenziny HP; renders (the return to antikholinesterazny) effect of inhibitors of cholinesterase, worsening a current of a malignant myasthenia.

It is necessary to be careful at simultaneous use with the HP increasing risk of bleeding (klopidogret, тиклопидин, selective serotonin reuptake inhibitors).

Contraindications:

Hypersensitivity, peptic ulcer of a stomach and 12-perstny gut in a stage of an aggravation or with tendency to bleeding, pregnancy (the III trimester), children's age (up to 18 years).

For LF containing lactose, sucrose (in addition): hereditary intolerance of fructose and/or galactose.

With care. Hypersensitivity (including to NPVP), a heavy ischemic heart disease (including unstable stenocardia, recently postponed myocardial infarction, dekompensirovanny HSN), bronchial asthma, allergic rhinitis, polyposes of a mucous membrane of a nose, recurrent stomach ulcer, an ulcer of a 12-perstny gut, HPN, a liver failure, deficit glucose-6-fosfatdegidrogenazy, pregnancy (the I-II trimester), the lactation period.

Overdose:

Symptoms (Dipiridamolum): feeling of heat, "inflows", perspiration, excitement state, weakness, dizziness, stenocardia, decrease in the ABP, tachycardia.

Symptoms (ASK): a hyperventilation, a ring in ears, nausea, vomiting, a vision disorder, a hearing disorder, dizziness, confusion of consciousness.

Treatment: gastric lavage, introduction of derivatives of xanthine (Aminophyllinum). The hemodialysis is inefficient.

Storage conditions:

Drug should be stored in the place, unavailable to children, at a temperature not above 25 °C. A period of validity - 3 years. Not to use drug after the expiry date specified on packaging.

Issue conditions:

According to the recipe

Packaging:

Capsules with the modified release on 30 pieces and 60 pieces in strip packagings and cardboard packs.