ASPIRIN

Therapeutic Class:
 Anticoagulants
 Antiplatelets & Fibronolytic(Thrombolytics)
 Nonsteroid Anti-Inflamatory Drugs( NSAIDs)
Mode of action:
Aspirin is a cyclooxygenase-1 (COX-1) inhibitor. It is a modifier of the enzymatic activity of cyclooxygenase-2
(COX-2). Unlike other NSAIDs (ibuprofen/naproxen), which bind reversibly to this enzyme, aspirin binding is
irreversible. It also blocks thromboxane A2 on platelets in an irreversible fashion preventing platelet aggregation
Available Dosage Strength
Contraindication
and Forms
Tablet Hypersensitivity to aspirin or other NSAIDs. Peptic ulcer, haemorrhagic disease,
 325 mg coagulation disorder (e.g. haemophilia, thrombocytopenia), gout. Severe hepatic and renal
 500 mg impairment. Children <16 years and recovering from viral infection. Pregnancy (doses
Delayed-release tablet >100 mg daily during 3rd trimester) and lactation. Concomitant use with other NSAIDs
 81 mg and methotrexate.
 325 mg Drug/ Food Interaction
 500 mg
 650 mg Drug: Increased risk of GI bleeding and ulceration with corticosteroids. Increased risk of
Chewable bleeding with coumarin anticoagulants (e.g. heparin, warfarin, phenindione) and
 81 mg antiplatelet agents (e.g. clopidogrel, dipyridamole). May result in severe acidosis and
Suppository increased CNS toxicity with carbonic anhydrase inhibitors (e.g. acetazolamide). Increases
 60 mg the hypoglycaemic effect of sulfonylureas. Reduces binding of phenytoin and valproate to
 120 mg serum albumin leading to increased free concentration of the drugs. Reduces the effect of
 200 mg uricosurics (e.g. probenecid, sulfinpyrazone). Impairs the renal excretion of lithium and
 300 mg digoxin.
 600 mg Potentially Fatal: Increased risk of GI bleeding and ulceration with other NSAIDs.
Intravenous Increased risk of haematological toxicity of methotrexate.
 250 mg Food: Increased risk of GI bleeding with alcohol. Reduced GI irritation with
 500 mg admin of food and large quantity of water or milk.

Warnings Side Effects

Common Side Effects Include:
 You should not use aspirin if you have a bleeding
disorder such as hemophilia, a recent history of
 Rash
stomach or intestinal bleeding, or if you are allergic to
an NSAID (non-steroidal anti-inflammatory drug)  Gastrointestinal Ulcerations
such as Advil, Motrin, Aleve, Orudis, Indocin, Lodine,  Abdominal Pain,
Voltaren, Toradol, Mobic, Relafen, Feldene, and  Upset Stomach
others.  Heartburn Drowsiness
 Do not give this medication to a child or teenager with  Headache
a fever, flu symptoms, or chickenpox.   Cramping
 Nausea
 Gastritis
 Bleeding

Special Precautions
Patient with dyspepsia or lesion of the GI mucosa, asthma or allergic disorders, anaemia, dehydration, menorrhagia,
uncontrolled hypertension, G6PD deficiency, thyrotoxicosis. Patients undergoing surgical procedures. Moderate hepatic
and renal impairment. Pregnancy.
 PERINDOPRIL
Therapeutic Class:
 Angiotensin-converting enzyme (ACE) inhibitors
 Direct Renin inhibitor
Mode of action:
ACE inhibitors bind to and inhibit the activity of both domains, but have much greater affinity for and inhibitory
activity against the C-domain. Perindoprilat, the active metabolite of perindopril, competes with ATI for binding to
ACE and inhibits and enzymatic proteolysis of ATI to ATII. Decreasing ATII levels in the body decreases blood
pressure by inhibiting the pressor effects of ATII as described in the Pharmacology section above. Perindopril also
causes an increase in plasma renin activity likely due to a loss of feedback inhibition mediated by ATII on the
release of renin and/or stimulation of reflex mechanisms via baroreceptors.
Available Dosage Strength
Contraindication
and Forms
History of angioedema related to previous ACE inhibitor treatment, hereditary
Tablet (Adult) or idiopathic angioedema, bilateral or unilateral renal stenosis, patients with
 2 mg extracorporeal treatments leading to contract of blooding with negatively
 4 mg charged surfaces. Concomitant use with aliskiren especially in patient with
 8mg diabetes mellitus or renal impairment (GFR <60 mL/min/1.73 m 2).
Concomitant use with sacubitril/valsartan. Pregnancy and lactation.
Drug/ Food Interaction
Drug: Increased hypotensive effect with antihypertensive agents, diuretics, nitrates and baclofen. Increased risk of
hyperkalaemia with K-sparing diuretics (e.g. spironolactone, eplerenone), K supplements, or other agents affecting
serum K concentrations (e.g. trimethoprim, ciclosporin, and heparin). May increase hypoglycaemic effect with insulin
and oral hypoglycaemic agents. Increased risk of angioedema with mammalian target of rapamycin (mTOR) inhibitors
(e.g. temsirolimus, sirolimus, everolimus), neutral endopeptidase (NEP) inhibitors (e.g. racecadotril), and dipeptidyl
peptidase-IV (DPP-IV) inhibitors (e.g. sitagliptin, linagliptin). Concomitant use with NSAIDs including selective COX-2
inhibitors may result to renal function deterioration and reduced antihypertensive effect. May increase serum levels and
toxicity of lithium. Coadministration with parenteral gold (e.g. Na aurothiomalate) may cause nitritoid reaction
characterized by facial flushing, nausea, vomiting, and hypotension.
Food: May reduce hepatic biotransformation with food.
Warnings Side Effects
 Not for pregnant or planning to be pregnant, this can harm Common side effects that can occur with use of
or end your pregnancy. Talk to your doctor about other perindopril include:
ways to lower your blood pressure if you become pregnant.  dizziness
If you get pregnant while taking perindopril, tell your  weakness
doctor right away.  headaches
 Low blood pressure warning: Perindopril can cause  upset stomach
hypotension (low blood pressure), especially during the  stomach pain
first few days of treatment. Tell your doctor if you feel  diarrhea
lightheaded or have any fainting spells. Your risk of low  cough
blood pressure may be higher if you: don’t drink enough  back pain
fluids, sweat heavily, have diarrhea or are vomiting, have  low blood pressure, which may make you feel
heart failure, are on dialysis and take diuretics (water pills) dizzy or faint
 Cough warning: Perindopril may cause a persistent, dry, If these effects are mild, they may disappear within a
non-productive cough. It will go away once you stop taking few days or a couple of weeks. If they’re more severe
this medication. or don’t disappear, talk to your doctor or pharmacist.

Special Precautions
Patient with hypertrophic cardiomyopathy with outflow tract obstruction, salt or volume depletion, collagen vascular
disease (e.g. SLE, scleroderma), severe mitral valve and aortic stenosis, ascites due to cirrhosis, refractory ascites,
diabetes, primary aldosteronism, CV disease (e.g. ischaemic heart disease). Patients undergoing major surgery or during
anaesthesia. Black race. Desensitisation treatment (e.g. hymenoptera venom). Renal and hepatic impairment. Elderly.