A fixed-dose combination (FDC) of three agents targeting different pathways in cardiovascular disease management. Aspirin is an irreversible cyclooxygenase-1 (COX-1) inhibitor providing antiplatelet action. Rosuvastatin is a competitive HMG-CoA reductase inhibitor for potent LDL-C reduction and plaque stabilization. Clopidogrel is a thienopyridine P2Y12 ADP receptor antagonist providing synergistic antiplatelet activity. This combination is primarily indicated for secondary prevention in patients with established atherosclerotic cardiovascular disease (ASCVD) to reduce the risk of major adverse cardiovascular events (MACE).
Adult: One tablet (Aspirin 75mg + Rosuvastatin 20mg + Clopidogrel 75mg) orally once daily. Rosuvastatin is usually taken in the evening but can be taken anytime; consistency is key. For ACS/PCI: Typically part of DAPT (with clopidogrel) for 6-12 months, often followed by single antiplatelet therapy, but statin (rosuvastatin) is lifelong.
Note: Swallow the tablet whole with a glass of water, with or without food. Taking with food may reduce GI upset from aspirin. Do not crush or chew. For patients unable to swallow, alternative forms (e.g., dispersible aspirin, separate statin) should be considered. Administer rosuvastatin at a consistent time each day.
This combination provides a multi-pronged attack on atherothrombosis. Aspirin irreversibly acetylates platelet cyclooxygenase-1 (COX-1), inhibiting thromboxane A2 synthesis, a potent platelet aggregator and vasoconstrictor. Clopidogrel irreversibly inhibits the P2Y12 subtype of the ADP receptor on the platelet surface, blocking ADP-mediated platelet activation and aggregation. Their antiplatelet effects are synergistic. Rosuvastatin competitively inhibits HMG-CoA reductase, the rate-limiting enzyme in hepatic cholesterol synthesis, leading to upregulation of LDL receptors and increased clearance of LDL from the bloodstream. It also exerts pleiotropic effects including plaque stabilization, improved endothelial function, and anti-inflammatory activity.
Pregnancy: CONTRANDICATED. Aspirin: Avoid in third trimester (risk of premature ductus arteriosus closure, bleeding in mother/fetus). Clopidogrel: Limited data, potential risk. Rosuvastatin: Contraindicated (cholesterol vital for fetal development). Category D (Rosuvastatin), Category D/C (Aspirin, high dose), Category B (Clopidogrel, but not recommended).
Driving: Generally no effect. However, dizziness, vertigo, or syncope (rare) may occur, especially initially. Patients should be cautioned about operating machinery if they experience such symptoms.
| Warfarin / DOACs (Apixaban, Rivaroxaban, Dabigatran) | Profoundly increased risk of major and fatal bleeding | Contraindicated / High |
| NSAIDs (Ibuprofen, Diclofenac, Naproxen) | Increased GI bleeding risk; pharmacodynamic interaction with aspirin | High |
| Proton Pump Inhibitors (Omeprazole, Esomeprazole) | Omeprazole/Esomeprazole are CYP2C19 inhibitors; may reduce clopidogrel activation. Pantoprazole is preferred. | Moderate |
| Fluconazole, Voriconazole (CYP2C19 inhibitors) | Reduce conversion of clopidogrel to active metabolite, diminishing antiplatelet effect | Moderate |
| Rifampicin (CYP inducer) | May reduce clopidogrel and rosuvastatin efficacy | Moderate |
| Cyclosporine, Gemfibrozil | Significantly increase rosuvastatin plasma levels, raising risk of myopathy/rhabdomyolysis. Avoid combination. | High |
| Warfarin | Aspirin displaces warfarin from protein binding and impairs platelet function, increasing INR and bleeding risk. | High |
| SSRIs (e.g., Sertraline, Escitalopram) | Increased bleeding risk due to impaired platelet serotonin uptake | Moderate |
| Systemic corticosteroids | Increased risk of GI ulceration and bleeding | Moderate |
Same composition (Aspirin (75mg) + Rosuvastatin (20mg) + Clopidogrel (75mg)), different brands: