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INTRODUCTION
CERUVIN AF CAPSULE is a combination of Aspirin and Clopidogrel which belongs to the group of medicines called Antiplatelets. CERUVIN AF CAPSULE is used in the prevention of early and long-term atherothrombotic events such as myocardial infarction (also known as heart attack), stroke (reduced blood supply to brain leading to brain death), cardiovascular death or refractory ischemia (chest pain due to inadequate blood supply to the heart) in patients having acute coronary syndrome with or without cardiac revascularization (including surgical or PCI, with or without stent insertion).
Acute coronary syndrome is a heart condition caused by plaque rupture or clot formation in the coronary arteries. Symptoms include heart attack, chest pressure or pain while at rest, shortness of breath and sweating.
Along treatment with CERUVIN AF CAPSULE follow a healthy low-fat diet as advised by doctor to achieve better results. Avoid drinking alcohol during treatment with CERUVIN AF CAPSULE, as it could increase the risk of bleeding in the gastrointestinal tract.
Do not stop taking CERUVIN AF CAPSULE abruptly without consulting your doctor because premature discontinuation of this medicine may increase the risk of cardiovascular events. CERUVIN AF CAPSULE is not recommended for use in patients having severe liver, kidney or lung disease.
CERUVIN AF CAPSULE is generally not recommended for use in pregnant or breastfeeding women and in children (below 18 years). Consult your doctor for an alternative therapy.
The most common side effects of taking CERUVIN AF CAPSULE are diarrhea, nausea, stomach pain and indigestion. Contact your doctor if any of the symptoms worsen.
USES OF CERUVIN AF CAPSULE
- To prevent atherothrombotic events (such as myocardial infarction, stroke, cardiovascular death or refractory ischemia) in patients having acute coronary syndrome with or without cardiac revascularization (including surgical or PCI, with or without stent insertion).
HOW CERUVIN AF CAPSULE WORKS
CERUVIN AF CAPSULE reduces the risk of heart problems, where clopidogrel acts by irreversibly inhibiting platelet aggregation in the coronary arteries and aspirin acts by blocking an enzyme called cyclo-oxygenase 1 which is believed to be responsible for catalyzing the synthesis of platelets, thus leading to the prevention of fatal cardiac outcomes.
DIRECTIONS FOR USE
Take CERUVIN AF CAPSULE as advised by your physician. Swallow CERUVIN AF CAPSULE with a glass of water. Do not crush or chew the medicine. Your doctor will decide the correct dose and duration for you depending upon your age, body weight and disease condition.
SIDE EFFECTS OF CERUVIN AF CAPSULE
COMMON
- diarrhea
- stomach pain
- indigestion or heartburn
UNCOMMON
- nausea or vomiting
- headache, dizziness
- ulcers in the stomach, constipation, flatulence
- skin rash or itching
- sensation of tingling and numbness in the body
- runny nose
- difficulty in breathing
RARE
- vertigo (spinning sensation)
- aplastic anemia
- cramps in lower respiratory tract, asthma attack
- gynecomastia (breast enlargement in male)
- menorrhagia (abnormal heavy or prolonged menstrual periods)
- generalized allergic reactions (such as overall heat sensation with sudden general discomfort until fainting)
- hemorrhagic vasculitis (inflammation of the blood vessels with bleeding)
- granulocytosis (increased granulocytes in peripheral blood)
- decreased platelet count (signs include easy bruising or bleeding)
- signs of low neutrophil count (sore throat, mouth ulcer or susceptible to infection)
Stop taking CERUVIN AF CAPSULE and contact your doctor immediately if you experience the following side effects:
- fever, signs of infection or extreme tiredness
- signs of Thrombotic Thrombocytopenic Purpura (such as jaundice, bruising under the skin that can appear as red pinpoints dots under the skin, confusion, fever, unexplained extreme tiredness and/or confusion)
- signs of allergic reactions (such as skin rashes, itching with blisters, swelling of the face, lips, mouth, throat or shock)
- signs of serious skin reactions like erythema multiforme, stevens-johnson syndrome or lyell’s syndrome (such as skin redness with blisters or peeling which may be associated with high fever and joint pain)
- signs of liver problems (yellowing of the skin or white of the eyes (jaundice), whether not associated with bleeding which appears under the skin (red pinpoint dots) and confusion
- unusual bleeding (such as bleeding in the brain, bruising under the skin, nasal bleeds, blood in urine, bleeding in the stomach or bowel leading to coughing up blood or black stools or bleeding in other parts of the body such as eyes, lungs or joints)
HOW TO MANAGE SIDE EFFECTS
Nausea and vomiting:
Try to take CERUVIN AF CAPSULE with or just after a meal or a snack. Stick to simple meals. Avoid eating rich or spicy food. Consult your doctor if the symptom did not improve.
Diarrhea:
Drink lot of fluids such as water or fruit juices to keep yourself hydrated. Avoid taking any medicine on your own for treating diarrhea. Consult your doctor if the symptom did not improve.
Headache:
Rest and relax. Drink plenty of fluids such as water or electrolytes. Apply a pain-relieving balm on the head if required. Do not consume too much of alcohol. Consult your doctor if the symptom did not improve.
Dizziness:
Try to rest and relax. Get enough sleep. Avoid driving or operating any tools or machines while you are feeling dizzy. Do not consume too much of alcohol, as it can aggravate your dizziness. Consult your doctor if the symptom did not improve.
Flatulence:
Eat smaller and frequent meals. Eat and drink slowly and exercise regularly. Consult your doctor if the symptom did not improve.
Constipation:
Eat fiber rich foods such as fresh fruits, vegetables and cereals and drink plenty of water. Try to exercise more regularly. Consult your doctor if the symptom did not improve on its own.
Indigestion:
Eat only when you are hungry. Try to eat smaller portions at a time. Always try to have a nutritious snack that is high in calories and protein, such as dried fruit and nuts. Consult your doctor if the symptom did not improve.
WARNING & PRECAUTIONS
PREGNANCY
CERUVIN AF CAPSULE is not recommended for use during pregnancy. Consult your doctor before taking CERUVIN AF CAPSULE.
BREASTFEEDING
CERUVIN AF CAPSULE is not recommended for use in breastfeeding women. Consult your doctor before taking CERUVIN AF CAPSULE.
DRIVING AND USING MACHINES
Do not drive or operate any heavy tools or machines if your ability is affected by CERUVIN AF CAPSULE.
ALCOHOL
Avoid consumption of alcohol while taking CERUVIN AF CAPSULE as it could increase the risk of gastrointestinal bleeding. Consult your doctor before taking CERUVIN AF CAPSULE.
KIDNEY
CERUVIN AF CAPSULE is not recommended for use in patients having severe kidney disease and should be used with caution in patients with kidney disease. Consult your doctor before taking CERUVIN AF CAPSULE.
LIVER
CERUVIN AF CAPSULE is not recommended for use in patients having severe liver disease and it should be used with caution in patients with liver disease. Consult your doctor before taking CERUVIN AF CAPSULE.
ALLERGY
Do not take CERUVIN AF CAPSULE if you are allergic to Aspirin, Clopidogrel or any other non-steroidal anti-inflammatory drugs (Ex. ibuprofen, celecoxib, etoricoxib).
LUNGS
CERUVIN AF CAPSULE is not recommended for use in patients having respiratory conditions such as asthma, nasal discharge (runny nose) or polyps (a type of growth in the nose). Consult your doctor before taking CERUVIN AF CAPSULE.
OTHERS
CERUVIN AF CAPSULE is not recommended for use if you:
- have coagulation disorders (Ex. hemophilia, thrombocytopenia)
- have bleeding in the brain (Ex. intracranial hemorrhage or cerebrovascular hemorrhage)
- have bleeding in the gastrointestinal tract
- have gout
- have menorrhagia (abnormally heavy or prolonged menstrual period)
Before taking CERUVIN AF CAPSULE, inform your physician if you:
- have stomach ulcer or severe stomach pain
- had a recent serious injury
- are going to have any upcoming surgery (including dental procedures) or already had recently
- had a recent ischemic stroke (blot clot in the artery supplying the brain)
- have a history of asthma or other allergic diseases
- are alcoholic
- have G6PD deficiency (a genetic disorder causing destruction of red blood cells in response to certain stimuli)
- have active chickenpox or shingles infection
Use in pediatrics:
CERUVIN AF CAPSULE is not recommended for use in children and adolescents (under 18 years of age). Consult your doctor for advice.
Use in geriatrics:
CERUVIN AF CAPSULE should be used with caution in elderly patients (aged 65 years and above). because of increased risk of gastro-intestinal bleeding and perforation when used for prolonged duration (if prolonged therapy is essential, patients should be reviewed regularly). Consult your doctor before taking CERUVIN AF CAPSULE.
INTERACTIONS
A. Drug-Drug interactions:
Before taking CERUVIN AF CAPSULE inform to your doctor, if you are taking any of these medicines:
- other anticoagulant medicines used to prevent blood clots (Ex. warfarin, heparin, coumarin) or dipyridamole
- medicines used to treat stomach ulcers such as antacids (Ex. aluminium hydroxide, magnesium hydroxide) and proton-pump inhibitors (Ex. omeprazole or esomeprazole)
- other non-steroidal anti-inflammatory drugs (Ex. ibuprofen, paracetamol)
- glycoprotein IIb/IIIa inhibitors (used during percutaneous coronary intervention) Ex. abciximab, eptifibatide and tirofiban
- medicines used to treat heart problems or hypertension (Ex. captopril, enalapril, lisinopril)
- selective serotonin reuptake inhibitors (used to treat depression) Ex. fluoxetine, sertraline, paroxetine etc
- methotrexate (used to treat cancer and other auto immune diseases)
- diuretics (used to increase urine output) Ex. furosemide, chlorothiazide
- acetazolamide (used to treat or prevent altitude sickness)
- digoxin (used to treat abnormal heart rate)
- lithium (used to treat metal illness)
- corticosteroids (used to treat pain and inflammation) Ex. prednisolone, dexamethasone
- medicines used to treat epilepsy (Ex. phenytoin, valproic acid)
- ciclosporin or tacrolimus (used to prevent graft rejection or treat auto-immune disease)
- ticlopidine (an antiplatelet medicine used to prevent heart problems)
- medicines used to treat gout (such as probenecid, sulfinpyrazone or benzbromarone)
- fluconazole or voriconazole (used to treat fungal infection)
- medicines used to treat HIV infection (Ex. efavirenz or tenofovir)
- varicella vaccine (used to prevent chickenpox or shingles)
- moclobemide (a medicine used to treat depression)
- medicines used to control blood glucose level (Ex. glipizide, gliclazide, glimepiride, repaglinide)
- paclitaxel (used to treat certain forms of cancer)
- nicorandil (used to treat chest pain)
- mifepristone (abortion pill)
- metoclopramide (used to prevent vomiting)
Overdosage:
If you or anyone else take too much of CERUVIN AF CAPSULE, contact your doctor immediately or go to a hospital straight away. Overdosage symptoms of CERUVIN AF CAPSULE might include increased bleeding, confusion, disorientation, coma, convulsions, vomiting, tinnitus (ringing in the ears), vertigo (spinning sensation), sweating, warm extremities with bounding pulses, increased respiratory rate, hyperventilation, low blood sugar levels, low potassium and platelets levels in blood, increased body temperature, kidney failure, respiratory alkalosis, metabolic acidosis and pulmonary edema (non-cardiac related).
SYNOPSIS
| Drug | : | Aspirin, Clopidogerl |
| Pharmacological Category | : | Antiplatelets |
| Therapeutic Indication | : | Myocardial infarction, Stroke, Cardiac death, Angina |
| Dosage Forms | : | Tablet, Capsule |
MORE INFORMATION
- Keep CERUVIN AF CAPSULE out of reach of children
- Store CERUVIN AF CAPSULE at room temperature
FAQs ABOUT CERUVIN AF CAPSULE
Can CERUVIN AF CAPSULE be taken at night?
Always take CERUVIN AF CAPSULE as advised by your physician. Your doctor will prescribe a suitable dose, frequency and time for you depending upon your age and existing disease condition. Before taking CERUVIN AF CAPSULE consult your doctor for more information regarding the direction of use.
Can I consume alcohol while taking CERUVIN AF CAPSULE?
No. Avoid consumption of alcohol while taking CERUVIN AF CAPSULE as it could aggravate your existing disease condition and increase the risk of bleeding. Before taking CERUVIN AF CAPSULE inform your doctor if you are alcoholic.
Can I take paracetamol along with CERUVIN AF CAPSULE?
Avoid concomitant use of non-steroidal anti-inflammatory drugs (NSAIDs) like paracetamol or ibuprofen while taking CERUVIN AF CAPSULE, because it may increase the risk of gastro-intestinal bleeding. Consult your doctor for an alternative pain relief medicine which can be used with CERUVIN AF CAPSULE.
Can CERUVIN AF CAPSULE be used in elderly patients?
Yes. CERUVIN AF CAPSULE can be used in elderly patients. It should be used with caution in elderly patients (aged 65 years and above) because of increased risk of gastro-intestinal bleeding and perforation when used for prolonged duration (if prolonged therapy is essential, patients should be reviewed regularly). Consult your doctor before taking CERUVIN AF CAPSULE.
Can CERUVIN AF CAPSULE be used in pregnancy?
No. CERUVIN AF CAPSULE is strictly not recommended for use during pregnancy. If you are pregnant or suspect that you are pregnant, you should inform your doctor before taking CERUVIN AF CAPSULE.
What to do If I forget to take CERUVIN AF CAPSULE?
You should take CERUVIN AF CAPSULE immediately when you remember. If it is time for your next dose of CERUVIN AF CAPSULE skip the dose and follow your regular dose schedule. Do not double the dose to match up your missed dose.
REFERENCES
1. KD. Tripathi. Drugs Affecting Coagulation, Bleeding and Thrombosis. Essentials of medical pharmacology. Seventh edition. 2013. Page – 629-633
2. Jeffery I. Weitz. Blood coagulation and Anticoagulant, Fibrinolytic and Antiplatelet Drugs. Goodman & Gilman’s: The Pharmacological basics of Therapeutics. 12th Edition. New York McGraw Hill Medical 2011. Page – 868-870
3. Gerald G. Briggs and Roger K. Freeman. C. A reference guide to fetal and neonatal risk: Drugs in Pregnancy and Lactation. Tenth Edition. 2015. Page – 888-891 & 288-29
4. Nai-Fang Chi, Chi-Pang Wen, Chung-Hsiang Liu, Jie-Yuan Li, Jiann-Shing Jeng, Chih-Hung Chen, Li-Ming Lien, Ching-Huang Lin, Yu Sun, Wei-Lun Chang, Chaur-Jong Hu, Chung Y. Hsu on behalf of and Taiwan Stroke Registry Investigators. Comparison Between Aspirin and Clopidogrel in Secondary Stroke Prevention Based on Real-World Data. Journal of American heart association. September 2018. [Accessed on 4th October 2021] https://www.ahajournals.org/doi/10.1161/JAHA.118.009856
5. S. Claiborne Johnston, J. Donald Easton, Mary Farrant, William Barsan, Robin A. Conwit, Jordan J. Elm, Anthony S. Kim, Anne S. Lindblad and Yuko Y. Palesch. Clopidogrel and Aspirin in Acute Ischemic Stroke and High-Risk TIA. The New England journal of Medicine. [Revised in July 2018]. [Accessed on 4th October 2021] https://www.nejm.org/doi/full/10.1056/nejmoa1800410
6. Shereif H. Rezkalla and Michele Benz. Antiplatelet Therapy from Clinical Trials to Clinical Practice. NCBI; PMC US National Library of Medicine, National Institute of Health. April 2003. [Accessed on 4th October 2021] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1069031/
7. Torrent Pharmaceuticals. Deplatt A. Torrentian.com. [Revised in July 2019]. [Accessed on 4th October 2021] https://www.torrentian.com/pisheet/Upload/PI_Sheet/2003.pdf
8. Cipla Ltd. Clopivas-AP Tablets (Clopidogrel + Aspirin). Ciplamed. [Revised in April 2017]. [Accessed on 4th October 2021] https://www.ciplamed.com/content/clopivas-ap-tablets
USEFUL DIAGNOSTIC TESTS
- Complete blood count
- Kidney function test
- Liver function test
AUTHOR DETAILS
Written By Dr. R. Dinesh John Rajkumar, Pharm.D
Last updated on 26 Oct 2022 | 02:33 PM(IST)
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