A fixed-dose combination (FDC) of three agents for comprehensive secondary prevention of atherothrombotic events. Aspirin and Clopidogrel provide synergistic antiplatelet action (dual antiplatelet therapy - DAPT) to prevent arterial thrombosis, while Atorvastatin provides lipid-lowering and plaque-stabilizing effects. This combination is a cornerstone in the management of patients with established cardiovascular disease (CVD) to reduce the risk of recurrent myocardial infarction (MI), stroke, and cardiovascular death.
Adult: One tablet (Aspirin 75mg + Atorvastatin 10mg + Clopidogrel 75mg) orally once daily. Usually taken in the evening for Atorvastatin (though timing is flexible).
Note: Swallow the tablet whole with a glass of water, with or without food. Can be taken at any time of day, but consistency is key. Do not crush or chew. If a dose is missed, take it as soon as remembered unless it's almost time for the next dose. Do NOT double the dose.
This combination exerts a multi-pronged attack on the atherothrombotic process. Aspirin irreversibly acetylates platelet cyclooxygenase-1 (COX-1), inhibiting thromboxane A2 (TXA2) synthesis, a potent platelet aggregator and vasoconstrictor. Clopidogrel is a prodrug whose active metabolite irreversibly blocks the P2Y12 subtype of ADP receptors on platelet surfaces, inhibiting ADP-mediated platelet activation and aggregation. Their effects are synergistic. Atorvastatin competitively inhibits HMG-CoA reductase, the rate-limiting enzyme in hepatic cholesterol synthesis, leading to upregulation of LDL receptors and increased clearance of LDL-C from blood. It also exerts pleiotropic effects including plaque stabilization, improved endothelial function, and anti-inflammatory actions.
Pregnancy: CATEGORY D (Aspirin/Atorvastatin). CONTRAINDICATED. Aspirin may cause premature closure of ductus arteriosus, increased maternal/neonatal bleeding, and intrauterine growth restriction. Statins are teratogenic and contraindicated. Clopidogrel: Category B, but combination is avoided.
Driving: Generally safe. However, dizziness or visual disturbances (rare side effects) may impair ability. Patients should be cautious until they know how the medicine affects them.
| Warfarin, NOACs (Apixaban, Rivaroxaban, etc.) | Profoundly increased risk of major bleeding. | Contraindicated/Severe |
| Other NSAIDs (Ibuprofen, Diclofenac) | Increased GI bleeding risk; may antagonize Aspirin's antiplatelet effect. | Major |
| Proton Pump Inhibitors (Omeprazole, Esomeprazole) | May reduce Clopidogrel's antiplatelet effect (CYP2C19 inhibition), particularly with Omeprazole/Esomeprazole. Pantoprazole is preferred. | Moderate |
| CYP3A4 Inhibitors (Ketoconazole, Itraconazole, Clarithromycin, HIV protease inhibitors) | Increase Atorvastatin exposure, raising risk of myopathy/rhabdomyolysis. | Major |
| CYP2C19 Inhibitors (Fluconazole, Fluoxetine, Citalopram) | May reduce conversion of Clopidogrel to active metabolite. | Moderate |
| Other Antiplatelets (Ticagrelor, Prasugrel) | Not used together; would be triple antiplatelet therapy with excessive bleeding risk. | Contraindicated |
| Fibrates (Gemfibrozil, Fenofibrate) | Increased risk of myopathy with Atorvastatin (Gemfibrozil risk > Fenofibrate). | Major |
| Methotrexate | Aspirin can reduce renal clearance of Methotrexate, increasing toxicity. | Major |
| SSRIs/SNRIs (Sertraline, Venlafaxine) | Additive risk of bleeding. | Moderate |
| Ginkgo Biloba, Garlic, Ginseng (Herbal) | Increased bleeding risk. | Moderate |
Same composition (Aspirin (75mg) + Atorvastatin (10mg) + Clopidogrel (75mg)), different brands: