The dose of a drug and dosage of the drug are two different terminologies. Dose is defined as the quantity or amount of medicine given by the doctor or taken by the patient at a given period. Dosage is the regimen prescribed by the doctor about how many days and how many times per day the drug is to be taken in specified dose by the patient. The dose is expressed in mg for tablets or gm, micro gm sometimes, ml for syrups or drops for kids syrups. The dose is not fixed for a drug for all conditions, and it changes according to the condition or a disease. It also changes on the age of the patient.
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Stromix - A 75 Dosage
Generic name: Stromix - A 75 bisulfate 75mg
Dosage form: tablet, film coated
The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.
Acute Coronary Syndrome
Stromix - A 75 can be administered with or without food.
For patients with non-ST-elevation ACS (UA/NSTEMI), initiate Stromix - A 75 with a single 300 mg oral loading dose and then continue at 75 mg once daily. Initiate aspirin (75–325 mg once daily) and continue in combination with Stromix - A 75.
For patients with STEMI, the recommended dose of Stromix - A 75 is 75 mg once daily orally, administered in combination with aspirin (75–325 mg once daily), with or without thrombolytics. Stromix - A 75 may be initiated with or without a loading dose.
Recent MI, Recent Stroke, or Established Peripheral Arterial Disease
The recommended daily dose of Stromix - A 75 is 75 mg once daily orally, with or without food.
CYP2C19 Poor Metabolizers
CYP2C19 poor metabolizer status is associated with diminished antiplatelet response to Stromix - A 75. Although a higher dose regimen in poor metabolizers increases antiplatelet response, an appropriate dose regimen for this patient population has not been established.
Use with Proton Pump Inhibitors (PPI)
Avoid using omeprazole or esomeprazole with Stromix - A 75. Omeprazole and esomeprazole significantly reduce the antiplatelet activity of Stromix - A 75. When concomitant administration of a PPI is required, consider using another acid-reducing agent with minimal or no CYP2C19 inhibitory effect on the formation of Stromix - A 75 active metabolite.
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Stromix - A 75
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What other drugs will affect Stromix - A 75?
Certain other medicines may increase your risk of bleeding. Tell your doctor if you take aspirin, especially if you have had a stroke. Talk to your doctor about whether you should take aspirin with Stromix - A 75. Ask a doctor or pharmacist before taking an NSAID (nonsteroidal anti-inflammatory drug), including ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others.
Tell your doctor about all other medicines you use to prevent blood clots, such as:
abciximab, eptifibatide, tirofiban;
dalteparin, enoxaparin, tinzaparin;
fondaparinux, ticlopidine;
heparin, warfarin, Coumadin; or
urokinase (Abbokinase).
Tell your doctor about all other medicines you use, and those you start or stop using during your treatment with Stromix - A 75, especially:
armodafinil or modafinil;
fluoxetine or fluvoxamine;
gemfibrozil;
isoniazid;
a cancer medication--dasatinib, letrozole, ibritumomab, or tositumomab;
certain stomach acid reducers--cimetidine, esomeprazole, omeprazole;
HIV medication--delavirdine, efavirenz, etravirine, tipranavir; or
seizure medication such as felbamate (Felbatol) or oxcarbazepine (Trileptal).
This list is not complete. Other drugs may interact with Stromix - A 75, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.
Stromix - A 75 interactions
Interactions are the effects that happen when the drug is taken along with the food or when taken with other medications. Suppose if you are taking a drug Stromix - A 75, it may have interactions with specific foods and specific medications. It will not interact with all foods and medications. The interactions vary from drug to drug. You need to be aware of interactions of the medicine you take. Most medications may interact with alcohol, tobacco, so be cautious.
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Oral Anticoagulants:
Because of the increased risk of bleeding, the concomitant administration of warfarin with Stromix - A 75 should be undertaken with caution.
Glycoprotein IIb/IIIa Inhibitors: As a pharmacodynamic interaction between Stromix - A 75 and glycoprotein IIb/IIIa inhibitors is possible, concomitant use should be undertaken with caution.
Acetylsalicylic Acid: Acetylsalicylic acid did not modify the Stromix - A 75-mediated inhibition of ADP-induced platelet aggregation, but Stromix - A 75 potentiated the effect of ASA on collagen-induced platelet aggregation. However, concomitant administration of ASA 500 mg twice daily for 1 day did not significantly increase the prolongation of bleeding time induced by Stromix - A 75 intake. As a pharmacodynamic interaction between Stromix - A 75 and ASA is possible, leading to increased risk of bleeding. Therefore, concomitant use should be undertaken with caution. However, Stromix - A 75 and ASA have been administered together for up to 1 year.
Injectable Anticoagulants: In a clinical study conducted in healthy subjects, Stromix - A 75 did not necessitate modification of the heparin dose or alter the effect of heparin on coagulation. Co-administration of heparin had no effect on the IPA induced by Stromix - A 75. As a pharmacodynamic interaction between Stromix - A 75 and heparin is possible, concomitant use should be undertaken with caution.
Thrombolytics: The safety of the concomitant administration of Stromix - A 75, thrombolytic agents and heparins was assessed in patients with acute MI. The incidence of clinically significant bleeding was similar to that observed when thrombolytic agents and heparins are co-administered with ASA.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): In a clinical study conducted in healthy volunteers, the concomitant administration of Stromix - A 75 and naproxen increased occult gastrointestinal blood loss. However, due to the lack of interaction studies with other NSAIDs, it is presently unclear whether there is an increased risk of gastrointestinal bleeding with all NSAIDs. Consequently, NSAIDs including COX-2 inhibitors and Stromix - A 75 should be co-administered with caution.
Selective Serotonin Reuptake Inhibitors (SSRIs): Since SSRIs affect platelet activation and increase the risk of bleeding, the concomitant administration of SSRIs with Stromix - A 75 should be undertaken with caution.
Other Concomitant Therapy: Since Stromix - A 75 is metabolised to its active metabolite partly by CYP2C19, use of drugs that inhibit the activity of this enzyme would be expected to result in reduced drug levels of the active metabolite of Stromix - A 75. The clinical relevance of this interaction is uncertain. Concomitant use of strong or moderate CYP2C19 inhibitors (eg, omeprazole) should be discouraged. If a proton-pump inhibitor is to be used concomitantly with Stromix - A 75, consider using one with less CYP2C19 inhibitory activity eg, pantoprazole.
Proton-Pump Inhibitors (PPI): In a crossover clinical study, Stromix - A 75 (300-mg loading dose followed by 75 mg/day) alone and with omeprazole (80 mg at the same time as Stromix - A 75) were administered for 5 days. The exposure to the active metabolite of Stromix - A 75 was decreased by 45% (day 1) and 40% (day 5) when Stromix - A 75 and omeprazole were administered together. Mean IPA with 5 mM ADP was diminished by 39% (24 hrs) and 21% (day 5) when Stromix - A 75 and omeprazole were administered together.
In a 2nd interaction study with omeprazole 80 mg administered 12 hrs apart from the Stromix - A 75 standard regimen, the results were similar, indicating that administering Stromix - A 75 and omeprazole at different times does not prevent their interaction that is likely to be driven by the inhibitory effect of omeprazole on CYP2C19.
In a 3rd interaction study with omeprazole 80 mg administered with a higher dose regimen of Stromix - A 75 (600-mg loading dose followed by 150 mg/day), a degree of interaction was observed similar to that noted in the other omeprazole interaction studies. However, active metabolite formation and platelet aggregation were at the same level as Stromix - A 75 administered alone at the standard dose regimen.
In a crossover clinical study, healthy subjects were administered Stromix - A 75 (300-mg loading dose followed by 75 mg/day) alone and with pantoprazole (80 mg at the same time as Stromix - A 75) for 5 days. The exposure to the active metabolite of Stromix - A 75 was decreased by 20% (day 1) and 14% (day 5) when Stromix - A 75 and pantoprazole were administered together. Mean IPA was diminished by 15% (24 hrs) and 11% (day 5) when Stromix - A 75 and pantoprazole were administered together. These results indicate that Stromix - A 75 can be administered with pantoprazole.
The CURRENT trial compared 2 dosing regimens of Stromix - A 75 (600-mg loading dose, then 150 mg/day for 6 days followed by 75 mg/day up to 30 days vs 300-mg loading dose followed by 75 mg/day up to 30 days). A subanalysis (n=18,432) correlated PPI use (mainly omeprazole and pantoprazole) at randomization and hospital discharge and demonstrated no interaction between Stromix - A 75 and PPI use for the primary endpoint (CV death, MI or stroke) or any secondary endpoints, including stent thrombosis.
A number of other clinical studies have been conducted with Stromix - A 75 and other concomitant medications to investigate the potential for pharmacodynamic and pharmacokinetic interactions. No clinically significant pharmacodynamic interactions were observed when Stromix - A 75 was co-administered with atenolol, nifedipine or both atenolol and nifedipine. Furthermore, the pharmacodynamic activity of Stromix - A 75 was not significantly influenced by the co-administration of phenobarbital, or oestrogen.
The pharmacokinetics of digoxin or theophylline were not modified by the co-administration of Stromix - A 75. Antacids did not modify the extent of Stromix - A 75 absorption.
Although the administration of Stromix - A 75 75 mg/day did not modify the pharmacokinetics of S-warfarin (a CYP2C9 substrate) or INR in patients receiving long-term warfarin therapy, co-administration of Stromix - A 75 with warfarin increases the risk of bleeding because of independent effects on hemostasis. However, at high concentrations in vitro, Stromix - A 75 inhibits CYP2C9. It is unlikely that Stromix - A 75 may interfere with the metabolism of drugs eg, phenytoin and tolbutamide and the NSAIDs, which are metabolised by cytochrome P-450 2C9. Data from the CAPRIE study indicate that phenytoin and tolbutamide can be safely co-administered with Stromix - A 75.
Apart from the specific drug interaction information described previously, interaction studies with Stromix - A 75 and some drugs commonly administered in patients with atherothrombotic disease have not been performed. However, patients entered into clinical trials with Stromix - A 75 received a variety of concomitant medications including diuretics, β-blockers, ACE inhibitors, calcium antagonists, cholesterol lowering agents, coronary vasodilators, antidiabetic agents (including insulin), antiepileptic agents, hormone replacement therapy and GP IIb/IIIa antagonists without evidence of clinically significant adverse interactions.
Incompatibilities: Not applicable.
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References
FDA/SPL Indexing Data. "A74586SNO7: The UNique Ingredient Identifier (UNII) is an alphanumeric substance identifier from the joint FDA/USP Substance Registration System (SRS).". https://www.fda.gov/ForIndustry/Data... (accessed September 17, 2018).
European Chemicals Agency - ECHA. "Thieno[3,2-c]pyridine-5(4H)-acetic acid, α-(2-chlorophenyl)-6,7-dihydro-, methyl ester, (αS)-: The information provided here is aggregated from the "Notified classification and labelling" from ECHA's C&L Inventory. ". https://echa.europa.eu/information-o... (accessed September 17, 2018).
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