NDC 62175-330 Aspirin And Extended-release Dipyridamole

Aspirin And Extended-release Dipyridamole

NDC Product Code 62175-330

NDC Code: 62175-330

Proprietary Name: Aspirin And Extended-release Dipyridamole What is the Proprietary Name?
The proprietary name also known as the trade name is the name of the product chosen by the medication labeler for marketing purposes.

Non-Proprietary Name: Aspirin And Extended-release Dipyridamole What is the Non-Proprietary Name?
The non-proprietary name is sometimes called the generic name. The generic name usually includes the active ingredient(s) of the product.


Product Characteristics
Color(s):
PINK (C48328 - OPAQUE)
YELLOW (C48330 - OPAQUE)
Shape: CAPSULE (C48336)
Size(s):
24 MM
Imprint(s):
LANNETT;330
Score: 1

Code Structure
  • 62175 - Lannett Company, Inc.
    • 62175-330 - Aspirin And Extended-release Dipyridamole

NDC 62175-330-35

Package Description: 60 CAPSULE, EXTENDED RELEASE in 1 BOTTLE

NDC Product Information

Aspirin And Extended-release Dipyridamole with NDC 62175-330 is a a human prescription drug product labeled by Lannett Company, Inc.. The generic name of Aspirin And Extended-release Dipyridamole is aspirin and extended-release dipyridamole. The product's dosage form is capsule, extended release and is administered via oral form.

Labeler Name: Lannett Company, Inc.

Dosage Form: Capsule, Extended Release - A solid dosage form in which the drug is enclosed within either a hard or soft soluble container made from a suitable form of gelatin, and which releases a drug (or drugs) in such a manner to allow a reduction in dosing frequency as compared to that drug (or drugs) presented as a conventional dosage form.

Product Type: Human Prescription Drug What kind of product is this?
Indicates the type of product, such as Human Prescription Drug or Human Over the Counter Drug. This data element matches the “Document Type” field of the Structured Product Listing.


Aspirin And Extended-release Dipyridamole Active Ingredient(s)

What is the Active Ingredient(s) List?
This is the active ingredient list. Each ingredient name is the preferred term of the UNII code submitted.

  • ASPIRIN 25 mg/1
  • DIPYRIDAMOLE 200 mg/1

Inactive Ingredient(s)

About the Inactive Ingredient(s)
The inactive ingredients are all the component of a medicinal product OTHER than the active ingredient(s). The acronym "UNII" stands for “Unique Ingredient Identifier” and is used to identify each inactive ingredient present in a product.

  • AMMONIA (UNII: 5138Q19F1X)
  • BUTYL ALCOHOL (UNII: 8PJ61P6TS3)
  • DIMETHICONE (UNII: 92RU3N3Y1O)
  • FERRIC OXIDE RED (UNII: 1K09F3G675)
  • FERRIC OXIDE YELLOW (UNII: EX438O2MRT)
  • FERROSOFERRIC OXIDE (UNII: XM0M87F357)
  • GELATIN (UNII: 2G86QN327L)
  • HYDROGENATED CASTOR OIL (UNII: ZF94AP8MEY)
  • HYPROMELLOSE 2910 (15 MPA.S) (UNII: 36SFW2JZ0W)
  • HYPROMELLOSE PHTHALATE (31% PHTHALATE, 40 CST) (UNII: G4U024CQK6)
  • ISOPROPYL ALCOHOL (UNII: ND2M416302)
  • METHACRYLIC ACID - METHYL METHACRYLATE COPOLYMER (1:2) (UNII: 5KY68S2577)
  • MICROCRYSTALLINE CELLULOSE (UNII: OP1R32D61U)
  • POVIDONE (UNII: FZ989GH94E)
  • PROPYLENE GLYCOL (UNII: 6DC9Q167V3)
  • SHELLAC (UNII: 46N107B71O)
  • STARCH, CORN (UNII: O8232NY3SJ)
  • TALC (UNII: 7SEV7J4R1U)
  • TARTARIC ACID (UNII: W4888I119H)
  • TITANIUM DIOXIDE (UNII: 15FIX9V2JP)
  • TRIACETIN (UNII: XHX3C3X673)

Administration Route(s)

What are the Administration Route(s)?
The translation of the route code submitted by the firm, indicating route of administration.

  • Oral - Administration to or by way of the mouth.

Pharmacological Class(es)

What is a Pharmacological Class?
These are the reported pharmacological class categories corresponding to the SubstanceNames listed above.

  • Cyclooxygenase Inhibitors - [MoA] (Mechanism of Action)
  • Decreased Prostaglandin Production - [PE] (Physiologic Effect)
  • Nonsteroidal Anti-inflammatory Compounds - [Chemical/Ingredient]
  • Nonsteroidal Anti-inflammatory Drug - [EPC] (Established Pharmacologic Class)
  • Platelet Aggregation Inhibitor - [EPC] (Established Pharmacologic Class)
  • Decreased Platelet Aggregation - [PE] (Physiologic Effect)
  • Decreased Platelet Aggregation - [PE] (Physiologic Effect)
  • Platelet Aggregation Inhibitor - [EPC] (Established Pharmacologic Class)

Product Labeler Information

What is the Labeler Name?
Name of Company corresponding to the labeler code segment of the Product NDC.

Labeler Name: Lannett Company, Inc.
Labeler Code: 62175
FDA Application Number: ANDA204552 What is the FDA Application Number?
This corresponds to the NDA, ANDA, or BLA number reported by the labeler for products which have the corresponding Marketing Category designated. If the designated Marketing Category is OTC Monograph Final or OTC Monograph Not Final, then the Application number will be the CFR citation corresponding to the appropriate Monograph (e.g. “part 341”). For unapproved drugs, this field will be null.

Marketing Category: ANDA - A product marketed under an approved Abbreviated New Drug Application. What is the Marketing Category?
Product types are broken down into several potential Marketing Categories, such as NDA/ANDA/BLA, OTC Monograph, or Unapproved Drug. One and only one Marketing Category may be chosen for a product, not all marketing categories are available to all product types. Currently, only final marketed product categories are included. The complete list of codes and translations can be found at www.fda.gov/edrls under Structured Product Labeling Resources.

Start Marketing Date: 03-20-2019 What is the Start Marketing Date?
This is the date that the labeler indicates was the start of its marketing of the drug product.

Listing Expiration Date: 12-31-2020 What is the Listing Expiration Date?
This is the date when the listing record will expire if not updated or certified by the product labeler.

Exclude Flag: N What is the NDC Exclude Flag?
This field indicates whether the product has been removed/excluded from the NDC Directory for failure to respond to FDA’s requests for correction to deficient or non-compliant submissions. Values = ‘Y’ or ‘N’.

* Please review the disclaimer below.

Aspirin And Extended-release Dipyridamole Product Label Images

Aspirin And Extended-release Dipyridamole Product Labeling Information

The product labeling information includes all published material associated to a drug. Product labeling documents include information like generic names, active ingredients, ingredient strength dosage, routes of administration, appearance, usage, warnings, inactive ingredients, etc.

Product Labeling Index

1 Indications And Usage

Aspirin and Extended-Release Dipyridamole Capsules are indicated to reduce the risk of stroke in patients who have had transient ischemia of the brain or completed ischemic stroke due to thrombosis.

2 Dosage And Administration

Aspirin and Extended-Release Dipyridamole Capsules are not interchangeable with the individual components of aspirin and dipyridamole tablets.The recommended dose of Aspirin and Extended-Release Dipyridamole Capsules is one capsule given orally twice daily, one in the morning and one in the evening. Swallow capsules whole without chewing. Aspirin and Extended-Release Dipyridamole Capsules can be administered with or without food.

2.1 Alternative Regimen In Case Of Intolerable Headaches

In the event of intolerable headaches during initial treatment, switch to one capsule at bedtime and low-dose aspirin in the morning. Because there are no outcome data with this regimen and headaches become less of a problem as treatment continues, patients should return to the usual regimen as soon as possible, usually within one week.

3 Dosage Forms And Strengths

No. 00 capsule with Pink Opaque cap and Yellow Opaque body imprinted in black with “Lannett” and “330”, and filled with pellets and powder blend.

4.1 Hypersensitivity

Aspirin and Extended-Release Dipyridamole Capsules are contraindicated in patients with known hypersensitivity to any of the product components.

4.2 Allergy

Aspirin is contraindicated in patients with known allergy to nonsteroidal anti-inflammatory drug (NSAID) products and in patients with the syndrome of asthma, rhinitis, and nasal polyps. Aspirin may cause severe urticaria, angioedema or bronchospasm.

4.3 Reye Syndrome

Do not use aspirin in children or teenagers with viral infections because of the risk of Reye syndrome.

5.1 Risk Of Bleeding

Aspirin and Extended-Release Dipyridamole Capsules increase the risk of bleeding. Risk factors for bleeding include the use of other drugs that increase the risk of bleeding (e.g., anticoagulants, antiplatelet agents, heparin, anagrelide, fibrinolytic therapy, and chronic use of NSAIDs) [see Drug Interactions (7.1)].Intracranial HemorrhageIn European Stroke Prevention Study-2 (ESPS2), the annualized event rate for intracranial hemorrhage was 0.39%/year in the Aspirin and Extended-Release Dipyridamole Capsules group, 0.26%/year in the extended-release dipyridamole (ER-DP) group, 0.24%/year in the aspirin (ASA) group and 0.29%/year in the placebo groups.Gastrointestinal (GI) Side EffectsGI side effects include stomach pain, heartburn, nausea, vomiting, and gross GI bleeding. Although minor upper GI symptoms, such as dyspepsia, are common and can occur anytime during therapy, physicians should remain alert for signs of ulceration and bleeding, even in the absence of previous GI symptoms. Inform patients about the signs and symptoms of GI side effects and what steps to take if they occur.In ESPS2, the annualized event rate for gastrointestinal bleeding was 2.97%/year in the Aspirin and Extended-Release Dipyridamole Capsules group, 1.58%/year in the extended-release dipyridamole group, 2.06%/year in the aspirin group, and 1.40%/year in the placebo groups.Peptic Ulcer DiseaseAvoid using aspirin in patients with a history of active peptic ulcer disease, which can cause gastric mucosal irritation and bleeding.Alcohol WarningBecause Aspirin and Extended-Release Dipyridamole Capsules contain aspirin, counsel patients who consume three or more alcoholic drinks every day about the bleeding risks involved with chronic, heavy alcohol use while taking aspirin.

5.2 Renal Failure

Avoid aspirin in patients with severe renal failure (glomerular filtration rate less than 10 mL/minute) [see Use in Specific Populations (8.6) and Clinical Pharmacology (12.3)].

5.3 Hepatic Insufficiency

Elevations of hepatic enzymes and hepatic failure have been reported in association with dipyridamole administration [see Use in Specific Populations (8.6) and Clinical Pharmacology (12.3)].

5.4 Coronary Artery Disease

Dipyridamole has a vasodilatory effect. Chest pain may be precipitated or aggravated in patients with underlying coronary artery disease who are receiving dipyridamole.For stroke or TIA patients for whom aspirin is indicated to prevent recurrent myocardial infarction (MI) or angina pectoris, the aspirin in this product may not provide adequate treatment for the cardiac indications.

5.5 Hypotension

Dipyridamole produces peripheral vasodilation, which can exacerbate pre-existing hypotension.

5.6 General

Aspirin and Extended-Release Dipyridamole Capsules are not interchangeable with the individual components of aspirin and dipyridamole tablets.

6 Adverse Reactions

  • The following adverse reactions are discussed
  • Elsewhere in the labeling:Hypersensitivity [see Contraindications (4.1)]Allergy [see Contraindications (4.2)]Risk of Bleeding [see Warnings and Precautions (5.1)]

6.1 Clinical Trials Experience

Because clinical
trials are conducted under widely varying conditions, adverse reaction
rates observed in the clinical trials of a drug cannot be directly
compared to rates in the clinical trials of another drug and may not
reflect the rates observed in practice.The efficacy and safety of Aspirin and Extended-Release Dipyridamole Capsules was established in the European Stroke Prevention Study-2 (ESPS2). ESPS2 was a double-blind, placebo-controlled study that evaluated 6602 patients over the age of 18 years who had a previous ischemic stroke or transient ischemic attack within ninety days prior to entry. Patients were randomized to either Aspirin and Extended-Release Dipyridamole Capsules, aspirin, ER-DP, or placebo [see Clinical Studies (14)]; primary endpoints included stroke (fatal or nonfatal) and death from all causes.This 24-month, multicenter, double-blind, randomized study (ESPS2) was conducted to compare the efficacy and safety of Aspirin and Extended-Release Dipyridamole Capsules with placebo, extended-release dipyridamole alone and aspirin alone. The study was conducted in a total of 6602 male and female patients who had experienced a previous ischemic stroke or transient ischemia of the brain within three months prior to randomization.Table 1 presents the annualized event rate for adverse events that occurred in 1%/year or more of patients treated with Aspirin and Extended-Release Dipyridamole Capsules where the incidence was also at least 1%/year greater than in those patients treated with placebo. There is no clear benefit of the dipyridamole/aspirin combination over aspirin with respect to safety.Table 1 Incidence of Adverse Events in ESPS2a  Individual Treatment GroupBody System/Preferred TermAspirin and Extended-Release Dipyridamole Capsules           n(%/year)bER-DP Alone      n(%/year)bASA Alone        n(%/year)bPlacebo             n(%/year)bNausea264(11.53)254(11.18)210 (8.32)232(9.53)Diarrhea210(9.17)257(11.31)112(4.44)161(6.61)Vomiting138(6.03)129(5.68) 101(4.00) 118(4.84) Platelet, Bleeding and Clotting DisordersHemorrhage NOS52(2.27)24(1.06)46(1.82)24(0.99)aReported by ≥1%/year of patients during Aspirin and Extended-Release Dipyridamole Capsules treatment where the incidence was at least 1%/year greater than in those treated with placebo.bAnnual event rate per 100 pt-years = 100* number of subjects with event/subject years. Subject-years is defined as cumulative number of days on treatment divided by 365.25.Note:  ER-DP = extended-release dipyridamole 200 mg; ASA = aspirin 25 mg. The dosage regimen for all treatment groups is BID. NOS = not otherwise specified.Total Number of Patients1650165416491649Central and Peripheral Nervous System DisordersHeadache647(28.25)634(27.91)558(22.10)543(22.29)Gastrointestinal System
DisordersDyspepsia303(13.23)288(12.68)299 (11.84)275(11.29)Abdominal Pain289(12.62)255(11.22)262(10.38)239(9.81)Discontinuation
due to adverse events in ESPS2 was 25% for Aspirin and Extended-Release Dipyridamole Capsules, 25% for extended-release
dipyridamole, 19% for aspirin, and 21% for placebo (refer to Table
2). Table 2 Incidence of Adverse Events that Led to the Discontinuation of Treatmenta   Treatment Groups    Aspirin and Extended-Release Dipyridamole Capsules        n(%/year)b  ER-DP             n(%/year)b  ASA                n(%/year)bPlacebo               n(%/year)b   Total Number of Patients 1650 1654 1649 1649Patients with at least one Adverse
Event that led to treatment discontinuation 417 (18.21) 419 (18.44) 318 (12.59) 352 (14.45)Headache165 (7.20) 166 (7.31) 57 (2.26) 69 (2.83)Nausea 91 (3.97) 95 (4.18) 51 (2.02)53  (2.18)Abdominal Pain 74 (3.23) 64 (2.82) 56 (2.22)52  (2.13)Vomiting 53 (2.31) 52 (2.29) 28 (1.11)24  (0.99)aReported by ≥1%/year of patients during Aspirin and Extended-Release Dipyridamole Capsules treatment where the incidence was at least 1%/year greater than in those treated with placebo.bAnnual event rate per 100 pt-years = 100* number of subjects with event/subject years. Subject-years is defined as cumulative number of days on treatment divided by 365.25. Note: ER-DP = extended-release dipyridamole 200 mg; ASA = aspirin 25 mg. The dosage regimen for all treatment groups is BID.Headache was most notable in the
first month of treatment.

6.2 Post-Marketing Experience

The following is a list of additional adverse
reactions that have been reported either in the literature or are
from post-marketing spontaneous reports for either dipyridamole or
aspirin. Because these reactions are reported voluntarily from a population
of uncertain size, it is not always possible to estimate reliably
their frequency or establish a causal relationship to drug exposure.
Decisions to include these reactions in labeling are typically based
on one or more of the following factors: (1) seriousness of the reaction,
(2) frequency of reporting, or (3) strength of causal connection to
Aspirin and Extended-Release Dipyridamole Capsules.Body as a Whole: Hypothermia, chest pain, allergic reaction, syncopeCardiovascular: Angina pectoris, hypotensionCentral Nervous System: Cerebral edema, dizziness, cerebral hemorrhage, intracranial hemorrhage, subarachnoid hemorrhageFluid and Electrolyte: Hyperkalemia, metabolic acidosis, respiratory alkalosis, hypokalemiaGastrointestinal: Pancreatitis, Reye syndrome, hematemesis, gastritis, ulceration and perforation, hemorrhage rectum, melena, GI hemorrhageHearing and Vestibular Disorders: Hearing lossHeart Rate and Rhythm Disorders: Tachycardia, palpitationImmune System Disorders: Hypersensitivity, acute anaphylaxis, laryngeal edemaLiver and Biliary System Disorders: Hepatitis, hepatic failure, cholelithiasis, jaundice, hepatic function abnormalMusculoskeletal: Rhabdomyolysis, myalgiaMetabolic and Nutritional Disorders: Hypoglycemia, dehydrationPlatelet, Bleeding and Clotting Disorders: Prolongation of the prothrombin time, disseminated intravascular coagulation,coagulopathy, thrombocytopenia, hematoma, gingival bleeding, epistaxis, purpuraPsychiatric Disorders: Confusion, agitationRespiratory: Tachypnea, dyspnea, hemoptysisSkin and Appendages Disorders: Rash, alopecia, angioedema, Stevens-Johnson syndrome, skin hemorrhages such as bruising,ecchymosis, and hematoma, pruritus, uticariaUrogenital: Interstitial nephritis, papillary necrosis, proteinuria, renal insufficiency and failure, hematuriaVascular (Extracardiac) Disorders: Allergic vasculitis, flushingOther Adverse Events: Anorexia, aplastic anemia, migraine, pancytopenia, thrombocytosis.

7.1 Drug Interaction Study Information Obtained From Literature

AdenosineDipyridamole has
been reported to increase the plasma levels and cardiovascular effects
of adenosine. Adjustment of adenosine dosage may be necessary.Angiotensin Converting Enzyme
(ACE) InhibitorsBecause of the indirect effect of
aspirin on the renin-angiotensin conversion pathway, the hyponatremic
and hypotensive effects of ACE inhibitors may be diminished by concomitant
administration of aspirin.AcetazolamideConcurrent use of aspirin and acetazolamide
can lead to high serum concentrations of acetazolamide (and toxicity)
due to competition at the renal tubule for secretion.Anticoagulants and AntiplateletsPatients taking Aspirin and Extended-Release Dipyridamole Capsules in combination with anticoagulants, antiplatelets,
or any substance impacting coagulation are at increased risk for bleeding.
Aspirin can displace warfarin from protein binding sites, leading
to prolongation of both the prothrombin time and the bleeding time.
Aspirin can increase the anticoagulant activity of heparin, increasing
bleeding risk.AnagrelidePatients taking aspirin in combination
with anagrelide are at an increased risk of bleeding.AnticonvulsantsSalicylic
acid can displace protein-bound phenytoin and valproic acid, leading
to a decrease in the total concentration of phenytoin and an increase
in serum valproic acid levels.Beta BlockersThe hypotensive effects
of beta blockers may be diminished by the concomitant administration
of aspirin due to inhibition of renal prostaglandins, leading to decreased
renal blood flow and salt and fluid retention.Cholinesterase InhibitorsDipyridamole may counteract the anticholinesterase effect of cholinesterase
inhibitors, thereby potentially aggravating myasthenia gravis.DiureticsThe
effectiveness of diuretics in patients with underlying renal or cardiovascular
disease may be diminished by the concomitant administration of aspirin
due to inhibition of renal prostaglandins, leading to decreased renal
blood flow and salt and fluid retention.MethotrexateSalicylate
can inhibit renal clearance of methotrexate, leading to bone marrow
toxicity, especially in the elderly or renal impaired.Nonsteroidal Anti-Inflammatory
Drugs (NSAIDs)The concurrent use of aspirin with
other NSAIDs may increase bleeding or lead to decreased renal function.Oral HypoglycemicsModerate doses of aspirin may increase the effectiveness of oral
hypoglycemic drugs, leading to hypoglycemia.Uricosuric Agents (probenecid and sulfinpyrazone)Salicylates antagonize the uricosuric action of uricosuric
agents.

8.1 Pregnancy

Risk SummaryAvailable data from published studies and postmarketing experience with Aspirin and Extended-Release Dipyridamole Capsules use during pregnancy have not identified a clear association between Aspirin and Extended-Release Dipyridamole Capsules use and major birth defects, miscarriage, or adverse maternal or fetal outcomes (see Data). Aspirin and Extended-Release Dipyridamole Capsules contain low-dose aspirin which is an NSAID (see Clinical Considerations). In animal reproduction studies, there were adverse developmental effects with administration of aspirin in rats and rabbits at doses about 66 and 44 times, respectively, the human exposure at the maximum recommended daily dose of aspirin-dipyridamole. Reproduction studies with dipyridamole in mice, rabbits, and rats have revealed no evidence of harm to the fetus up to doses about 25 times the maximum recommended daily human dose of aspirin-dipyridamole. Nonclinical data are suggestive of a possible potentiation of aspirin-related fetal toxicity when combined with dipyridamole (see Data).The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4 and 15-20%, respectively.Clinical ConsiderationsLabor and DeliveryAspirin and Extended-Release Dipyridamole Capsules, which contains dipyridamole and low-dose aspirin, increases the risk for bleeding [see Warnings and Precautions (5.1)]. Maternal use of high-dose aspirin can result in excessive blood loss at delivery, prolonged gestation, prolonged labor, intracranial hemorrhage in premature infants, low birth weight, stillbirth, and neonatal death.DataHuman DataPublished data from clinical trials, observational studies, case series, and case reports over several decades have not identified a clear association between aspirin-dipyridamole use in pregnancy and major birth defects, miscarriage, or adverse maternal or fetal outcomes. However, these studies cannot definitively establish the absence of any aspirin-dipyridamole associated risks. Methodological limitations of these studies include variability in the timing and dose of drug exposure (e.g., most exposures occurred beyond the first trimester) and the small sample sizes of individual studies.Animal DataAspirin has been shown to be teratogenic in rats (spina bifida, exencephaly, microphthalmia and coelosomia) and rabbits (congested fetuses, agenesis of skull and upper jaw, generalized edema with malformation of the head, and diaphanous skin) at oral doses of 330 mg/kg/day and 110 mg/kg/day, respectively. These doses, which also resulted in a high resorption rate in rats (63% of implantations versus 5% in controls), are, on a mg/m2 basis, about 66 and 44 times, respectively, the dose of aspirin contained in the maximum recommended daily human dose of aspirin-dipyridamole. Reproduction studies with dipyridamole have been performed in mice, rabbits and rats at oral doses of up to 125 mg/kg, 40 mg/kg, and 1000 mg/kg, respectively (about 1½, 2, and 25 times the maximum recommended daily human oral dose, respectively, on a mg/m2 basis) and have revealed no evidence of harm to the fetus due to dipyridamole. When 330 mg aspirin/kg/day was combined with 75 mg dipyridamole/kg/day in the rat at doses about 66 and 2 times, respectively, the maximum recommended daily human dose, the resorption rate approached 100%.

8.2 Lactation

Risk SummaryBased on data from a clinical lactation study in breastfeeding women taking low-dose aspirin, the metabolite salicylic acid is present in human milk in low levels (see Data). Dipyridamole is also present in human milk. There is no information on the effects of Aspirin and Extended-Release Dipyridamole Capsules or dipyridamole on the breastfed infant or on milk production. There is insufficient information to determine the effects of aspirin on the breastfed infant and no information on the effects of aspirin on milk production. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for Aspirin and Extended-Release Dipyridamole Capsules and any potential adverse effects on the breastfed child from Aspirin and Extended-Release Dipyridamole Capsules or from the underlying maternal condition.DataA published clinical study involved six exclusively breastfeeding women at 1 to 8 months postpartum who were taking 81 mg aspirin daily. Milk samples were collected at steady state, at 0, 1, 2, 4, 8, 12, and 24 hours after taking a dose of aspirin. Aspirin was undetectable in human milk. Salicylic acid was present in milk at low levels (average concentration of 24 ng/mL). Based on an average milk consumption of 150 mL/kg/day, the calculated relative infant dose was 0.4%. No adverse effects on the breastfed infants were noted.

8.4 Pediatric Use

Safety and effectiveness of Aspirin and Extended-Release Dipyridamole Capsules in pediatric patients have not been studied. Because of the aspirin component, use of this product in the pediatric population is not recommended [see Contraindications (4.3)].

8.5 Geriatric Use

Of the total number of subjects in ESPS2, 61% were 65 and over, while 27% were 75 and over. No overall differences in safety or effectiveness were observed between these subjects and younger subjects, and other reported clinical experience has not identified differences in responses between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out [see Clinical Pharmacology (12.3)].

8.6 Patients With Severe Hepatic Or Severe Renal Dysfunction

Aspirin and Extended-Release Dipyridamole Capsules have not been studied in patients with hepatic or renal impairment. Avoid using aspirin containing products, such as Aspirin and Extended-Release Dipyridamole Capsules, in patients with severe hepatic or severe renal (glomerular filtration rate < 10 mL/min) dysfunction [see Warnings and Precautions (5.2, 5.3) and Clinical Pharmacology (12.3)].

10 Overdosage

Because
of the dose ratio of dipyridamole to aspirin, overdosage of Aspirin and Extended-Release Dipyridamole Capsules is likely to be dominated by signs and symptoms of dipyridamole overdose.
In case of real or suspected overdose, seek medical attention or contact
a Poison Control Center immediately. Careful medical management is
essential.Based upon the known
hemodynamic effects of dipyridamole, symptoms such as warm feeling,
flushes, sweating, restlessness, feeling of weakness, and dizziness
may occur. A drop in blood pressure and tachycardia might also be
observed.Salicylate toxicity
may result from acute ingestion (overdose) or chronic intoxication.
Severity of aspirin intoxication is determined by measuring the blood
salicylate level. The early signs of salicylic overdose (salicylism),
including tinnitus (ringing in the ears), occur at plasma concentrations
approaching 200 µg/mL. In severe cases, hyperthermia and hypovolemia
are the major immediate threats to life. Plasma concentrations of
aspirin above 300 µg/mL are clearly toxic. Severe toxic effects are
associated with levels above 400 µg/mL. A single lethal dose of aspirin
in adults is not known with certainty but death may be expected at
30 g.Treatment of overdose consists
primarily of supporting vital functions, increasing drug elimination,
and correcting acid-base disturbances. Consider gastric emptying and/or
lavage as soon as possible after ingestion, even if the patient has
vomited spontaneously. After lavage and/or emesis, administration
of activated charcoal as a slurry may be beneficial if less than 3
hours have passed since ingestion. Charcoal absorption should not
be employed prior to emesis and lavage. Follow acid-base status closely
with serial blood gas and serum pH measurements. Maintain fluid and
electrolyte balance. Administer replacement fluid intravenously and
augment with correction of acidosis. Treatment may require the use
of a vasopressor. Infusion of glucose may be required to control hypoglycemia.Administration of xanthine derivatives
(e.g., aminophylline) may reverse the vasodilatory effects of dipyridamole
overdose. Plasma electrolytes and pH should be monitored serially
to promote alkaline diuresis of salicylate if renal function is normal.
In patients with renal insufficiency or in cases of life-threatening
intoxication, dialysis is usually required to treat salicylic overdose;
however, since dipyridamole is highly protein bound, dialysis is not
likely to remove dipyridamole. Exchange transfusion may be indicated
in infants and young children.

11 Description

Aspirin and Extended-Release Dipyridamole Capsules are a combination antiplatelet agent intended for oral administration. Each hard gelatin capsule contains 200 mg dipyridamole in an extended-release pellet form and 25 mg aspirin in an immediate-release powder form. In addition, each capsule contains the following inactive ingredients: hydrogenated castor oil, hypromellose 2910, hypromellose phthalate, methacrylic acid copolymer, microcrystalline cellulose, povidone, simethicone emulsion, starch, talc, tartaric acid and triacetin. The imprinting ink also contains ammonium hydroxide, n-butyl alcohol, black iron oxide, isopropyl alcohol, propylene glycol and shellac glaze.Each capsule shell contains gelatin, red iron oxide and yellow iron oxide and titanium dioxide.

12.1 Mechanism Of Action

The antithrombotic action of Aspirin and Extended-Release Dipyridamole Capsules is the result of the additive antiplatelet effects of dipyridamole and aspirin.

12.2 Pharmacodynamics

The effect of either agent on the other's inhibition of platelet reactivity has not been evaluated.

12.3 Pharmacokinetics

There are no significant interactions between aspirin and dipyridamole. The kinetics of the components are unchanged by their co-administration as Aspirin and Extended-Release Dipyridamole Capsules.AbsorptionDipyridamole:Peak plasma levels of dipyridamole are achieved 2 hours (range 1–6 hours) after administration of a daily dose of 400 mg Aspirin and Extended-Release Dipyridamole Capsules (given as 200 mg BID). The peak plasma concentration at steady-state is 1.98 μg/mL (1.01–3.99 μg/mL) and the steady-state trough concentration is 0.53 μg/mL (0.18–1.01 μg/mL).Aspirin:Peak plasma levels of aspirin are achieved 0.63 hours (0.5–1 hour) after administration of a 50 mg aspirin daily dose from Aspirin and Extended-Release Dipyridamole Capsules (given as 25 mg BID). The peak plasma concentration at steady-state is 319 ng/mL (175-463 ng/mL). Aspirin undergoes moderate hydrolysis to salicylic acid in the liver and the gastrointestinal wall, with 50%–75% of an administered dose reaching the systemic circulation as intact aspirin.Effect of FoodDipyridamole:When Aspirin and Extended-Release Dipyridamole Capsules were taken with a high fat meal, dipyridamole peak plasma levels (Cmax) and total absorption (AUC) were decreased at steady-state by 20-30% compared to fasting. Due to the similar degree of inhibition of adenosine uptake at these plasma concentrations, this food effect is not considered clinically relevant.Aspirin:When Aspirin and Extended-Release Dipyridamole Capsules were taken with a high fat meal, there was no difference for aspirin in AUC at steady-state, and the approximately 50% decrease in Cmax was not considered clinically relevant based on a similar degree of cyclooxygenase inhibition comparing the fed and fasted state. DistributionDipyridamole:Dipyridamole is highly lipophilic (log P=3.71, pH=7); however, it has been shown that the drug does not cross the blood-brain barrier to any significant extent in animals. The steady-state volume of distribution of dipyridamole is about 92 L. Approximately 99% of dipyridamole is bound to plasma proteins, predominantly to alpha 1-acid glycoprotein and albumin.Aspirin:Aspirin is poorly bound to plasma proteins and its apparent volume of distribution is low (10 L). Its metabolite, salicylic acid, is highly bound to plasma proteins, but its binding is concentration-dependent (nonlinear). At low concentrations (<100 mcg/mL), approximately 90% of salicylic acid is bound to albumin. Salicylic acid is widely distributed to all tissues and fluids in the body, including the central nervous system, breast milk, and fetal tissues. Early signs of salicylate overdose (salicylism), including tinnitus (ringing in the ears), occur at plasma concentrations approximating 200 mcg/mL [see Overdosage (10)].Metabolism and EliminationDipyridamole:Dipyridamole is metabolized in the liver, primarily by conjugation with glucuronic acid, of which monoglucuronide which has low pharmacodynamic activity is the primary metabolite. In plasma, about 80% of the total amount is present as parent compound and 20% as monoglucuronide. Most of the glucuronide metabolite (about 95%) is excreted via bile into the feces, with some evidence of enterohepatic circulation. Renal excretion of parent compound is negligible and urinary excretion of the glucuronide metabolite is low (about 5%). With intravenous (i.v.) treatment of dipyridamole, a triphasic profile is obtained: a rapid alpha phase, with a half-life of about 3.4 minutes, a beta phase, with a half-life of about 39 minutes, (which, together with the alpha phase accounts for about 70% of the total area under the curve, AUC) and a prolonged elimination phase λz with a half-life of about 15.5 hours. Because of the extended absorption phase of the dipyridamole component, only the terminal phase is apparent from oral treatment with Aspirin and Extended-Release Dipyridamole Capsules which was 13.6 hours.Aspirin:Aspirin is rapidly hydrolyzed in plasma to salicylic acid, with a half-life of 20 minutes. Plasma levels of aspirin are essentially undetectable 2-2.5 hours after dosing and peak salicylic acid concentrations occur 1 hour (range: 0.5-2 hours) after administration of aspirin. Salicylic acid is primarily conjugated in the liver to form salicyluric acid, a phenolic glucuronide, an acyl glucuronide, and a number of minor metabolites. Salicylate metabolism is saturable and total body clearance decreases at higher serum concentrations due to the limited ability of the liver to form both salicyluric acid and phenolic glucuronide. Following toxic doses (10-20 g), the plasma half-life may be increased to over 20 hours.The elimination of acetylsalicylic acid follows first-order kinetics with Aspirin and Extended-Release Dipyridamole Capsules and has a half-life of 0.33 hours. The half-life of salicylic acid is 1.71 hours. Both values correspond well with data from the literature at lower doses which state a resultant half-life of approximately 2-3 hours. At higher doses, the elimination of salicylic acid follows zero-order kinetics (i.e., the rate of elimination is constant in relation to plasma concentration), with an apparent half-life of 6 hours or higher. Renal excretion of unchanged drug depends upon urinary pH. As urinary pH rises above 6.5, the renal clearance of free salicylate increases from <5% to >80%. Alkalinization of the urine is a key concept in the management of salicylate overdose [see Overdosage (10)]. Following therapeutic doses, about 10% is excreted as salicylic acid and 75% as salicyluric acid, as the phenolic and acyl glucuronides, in urine.Specific PopulationsGeriatric Patients:Dipyridamole:In ESPS2 [see Clinical Studies (14)], plasma concentrations (determined as AUC) of dipyridamole in healthy elderly subjects (>65 years) were about 40% higher than in subjects younger than 55 years receiving treatment with Aspirin and Extended-Release Dipyridamole Capsules.Hepatic Dysfunction:No study has been conducted with Aspirin and Extended-Release Dipyridamole Capsules in patients with hepatic dysfunction.Dipyridamole:In a study conducted with an intravenous formulation of dipyridamole, patients with mild to severe hepatic insufficiency showed no change in plasma concentrations of dipyridamole but showed an increase in the pharmacologically inactive monoglucuronide metabolite. Dipyridamole can be dosed without restriction as long as there is no evidence of hepatic failure.Aspirin:Avoid aspirin in patients with severe hepatic insufficiency.Renal Dysfunction: Dipyridamole:In ESPS2 patients [see Clinical Studies (14)], with creatinine clearances ranging from about 15 mL/min to >100 mL/min, no changes were observed in the pharmacokinetics of dipyridamole or its glucuronide metabolite if data were corrected for differences in age.Aspirin:Avoid aspirin in patients with severe renal failure (glomerular filtration rate <10 mL/min).Drug Interaction StudiesA dedicated drug interaction study was conducted in 60 healthy volunteers to evaluate the effects of omeprazole 80 mg administered once daily on the pharmacokinetics (PK) of dipyridamole and the pharmacodynamics (PD) of acetylsalicylic acid when co-administered with Aspirin and Extended-Release Dipyridamole Capsules twice daily. Dipyridamole exposure (Cmax and AUC) at steady-state were similar with or without omeprazole co-administration. The pharmacokinetics of acetylsalicylic acid was not characterized. However, the antiplatelet activity as measured by arachidonic acid induced platelet aggregation was similar between the treatment arms at steady-state.

13.1 Carcinogenesis, Mutagenesis, Impairment Of Fertility

In studies in which dipyridamole was administered in the feed to mice (up to 111 weeks in males and females) and rats (up to 128 weeks in males and up to 142 weeks in females), there was no evidence of drug-related carcinogenesis. The highest dose administered in these studies (75 mg/kg/day) was, on a mg/m2 basis, about equivalent to the maximum recommended daily human oral dose (MRHD) in mice and about twice the MRHD in rats.Combinations of dipyridamole and aspirin (1:5 ratio) tested negative in the Ames test, in vivo chromosome aberration tests (in mice and hamsters), oral micronucleus tests (in mice and hamsters) and oral dominant lethal test (in mice). Aspirin, alone, induced chromosome aberrations in cultured human fibroblasts. Mutagenicity tests of dipyridamole alone with bacterial and mammalian cell systems were negative.Combinations of dipyridamole and aspirin have not been evaluated for effects on fertility and reproductive performance. There was no evidence of impaired fertility when dipyridamole was administered to male and female rats at oral doses up to 500 mg/kg/day (about 12 times the MRHD on a mg/m2 basis). A significant reduction in number of corpora lutea with consequent reduction in implantations and live fetuses was, however, observed at 1250 mg/kg (more than 30 times the MRHD on a mg/m2 basis). Aspirin inhibits ovulation in rats.

14 Clinical Studies

ESPS2 (European Stroke Prevention Study-2) was a double-blind, placebo-controlled, 24-month study in which 6602 patients over the age of 18 years had an ischemic stroke (76%) or transient ischemic attack (TIA, 24%) within three months prior to entry. Patients were enrolled in 13 European countries between February 1989 and May 1995 and were randomized to one of four treatment groups: Aspirin and Extended-Release Dipyridamole Capsules ­25 mg/200 mg; extended-release dipyridamole (ER-DP) 200 mg alone; aspirin (ASA) 25 mg alone; or placebo. The mean age in this population was 66.7 years with 58% of them being males. Patients received one capsule twice daily (morning and evening). Efficacy assessments included analyses of stroke (fatal or nonfatal) and death (from all causes) as confirmed by a blinded morbidity and mortality assessment group. There were no differences with regard to efficacy based on age or gender; patients who were older had a trend towards more events.Stroke EndpointAspirin and Extended-Release Dipyridamole Capsules reduced the risk of stroke by 22.1% compared to aspirin 50 mg/day alone (p = 0.008) and reduced the risk of stroke by 24.4% compared to extended-release dipyridamole 400 mg/day alone (p = 0.002) (Table 3). Aspirin and Extended-Release Dipyridamole Capsules reduced the risk of stroke by 36.8% compared to placebo (p <0.001).

16 How Supplied/Storage And Handling

Aspirin and Extended-Release Dipyridamole Capsules are available as a No. 00 capsule with Pink Opaque cap and Yellow Opaque body imprinted in black with “Lannett” and “330”, and filled with pellets and powder blend.Aspirin and Extended-Release Dipyridamole Capsules are supplied in unit-of-use bottles of 60 capsules (NDC 62175-330-35).Store at 25°C (77°F); excursions permitted to 15°-30°C (59°-86°F) [see USP Controlled Room Temperature]. Protect from excessive moisture.

17 Patient Counseling Information

  • Advise the patient to read the FDA-approved patient
  • Labeling (Patient Information).Risk of BleedingInform patients
  • That as with other antiplatelet agents, there is a general risk of
  • Bleeding including intracranial and gastrointestinal bleeding. Inform
  • Patients about the signs and symptoms of bleeding, including occult
  • Bleeding. Tell patients to notify their physician if they are prescribed
  • Any drug which may increase risk of bleeding.Counsel patients who consume three or more alcoholic drinks daily
  • About the bleeding risks involved with chronic, heavy alcohol use
  • While taking aspirin.PregnancyAdvise patients to notify their healthcare provider if they become pregnant or intend to become pregnant during treatment with Aspirin and Extended-Release Dipyridamole Capsules [see Use in Specific Populations (8.1)].HeadachesSome patients may experience
  • Headaches upon treatment initiation; these are usually transient.
  • In case of intolerable headaches, tell patients to contact their
  • Physician.Dosage and AdministrationTell patients
  • That Aspirin and Extended-Release Dipyridamole Capsules should be swallowed whole, and not chewed or
  • Crushed. If you miss a dose, continue with your next dose on your
  • Regular schedule. Do not take a double dose.StorageInform patients to protect
  • Aspirin and Extended-Release Dipyridamole Capsules from moisture.

Patient Information

  • Aspirin (as-per-in) and Extended-Release Dipyridamole (dahy-pir-i-duh-mohl) Capsules Read this Patient Information before you
  • Start taking Aspirin and Extended-Release Dipyridamole Capsules and each time you get a refill. There may be
  • New information. This information does not take the place of talking
  • To your healthcare provider about your medical condition or your treatment.What is Aspirin and Extended-Release Dipyridamole Capsules?Aspirin and Extended-Release Dipyridamole Capsules are a prescription
  • Medicine that contains aspirin and a medicine that is slowly released
  • In your body, called dipyridamole. Aspirin and Extended-Release Dipyridamole Capsules are used to lower the risk
  • Of stroke in people who have had a "mini-stroke" (transient ischemic
  • Attack or TIA) or stroke due to a blood clot.It is not known if Aspirin and Extended-Release Dipyridamole Capsules are safe and effective in
  • Children. See "Who should not take Aspirin and Extended-Release Dipyridamole Capsules?"Who should not take Aspirin and Extended-Release Dipyridamole Capsules?Do not
  • Take Aspirin and Extended-Release Dipyridamole Capsules if you:are allergic to any of the ingredients in Aspirin and Extended-Release Dipyridamole Capsules. See
  • The end of this leaflet for a list of ingredients in Aspirin and Extended-Release Dipyridamole Capsules.are allergic to non-steroidal anti-inflammatory drugs (NSAIDs)have asthma in combination with runny nose and nasal polypsDo not give Aspirin and Extended-Release Dipyridamole Capsules to a child or teenager with a viral illness. Reye syndrome, a life-threatening
  • Condition, can happen when aspirin (an ingredient in Aspirin and Extended-Release Dipyridamole Capsules) is
  • Used in children and teenagers who have certain viral illnesses.What
  • Should I tell my doctor before using Aspirin and Extended-Release Dipyridamole Capsules?Before taking Aspirin and Extended-Release Dipyridamole Capsules,
  • Tell your healthcare provider if you:have stomach ulcershave a history of bleeding problemshave heart problemshave kidney or liver problemshave low blood pressurehave myasthenia gravishave any other medical conditionsare pregnant or plan to become pregnant. You should not take Aspirin and Extended-Release Dipyridamole Capsules during pregnancy without first talking to your healthcare provider. Tell your healthcare provider right away if you become pregnant while taking Aspirin and Extended-Release Dipyridamole Capsules.are breast-feeding or plan to breast-feed. Aspirin and Extended-Release Dipyridamole Capsules can pass into your milk. Talk to your healthcare provider about the best way to feed your baby if you take Aspirin and Extended-Release Dipyridamole Capsules.Tell your doctor about all
  • The medicines you take, including prescription and non-prescription
  • Medicines, vitamins and herbal supplements. Aspirin and Extended-Release Dipyridamole Capsules and other medicines
  • May affect each other causing side effects. Aspirin and Extended-Release Dipyridamole Capsules may affect the
  • Way other medicines work, and other medicines may affect how Aspirin and Extended-Release Dipyridamole Capsules works.Especially tell your healthcare
  • Provider if you take:a medicine for high blood pressure, irregular
  • Heart beat, or heart failureacetazolamide [Diamox®]any blood thinner medicines warfarin sodium [Coumadin®, Jantoven®]a heparin medicineanagrelide [Agrylin®]a seizure medicinea medicine for Alzheimer’s diseasea water pillmethotrexate sodium [Trexall®]aspirin or a non-steroidal anti-inflammatory
  • Drug (NSAIDs). You should not take NSAIDs during treatment with Aspirin and Extended-Release Dipyridamole Capsules. Using these medicines with Aspirin and Extended-Release Dipyridamole Capsules can increase your risk
  • Of bleeding.a medicine for diabetesprobenecid [Probalan®, Col-Probenecid®]Ask your healthcare provider or pharmacist
  • If you are not sure if your medicine is one that is listed above. Know the medicines you take. Keep a list
  • Of them and show your healthcare provider and pharmacist when you
  • Get a new medicine.How should I take Aspirin and Extended-Release Dipyridamole Capsules?Take Aspirin and Extended-Release Dipyridamole Capsules exactly as prescribed. Your healthcare provider
  • Will tell you how many Aspirin and Extended-Release Dipyridamole Capsules to take and when to take them.Headaches are not uncommon when you first start taking Aspirin and Extended-Release Dipyridamole Capsules,
  • But often lessen as treatment continues. Tell your healthcare provider
  • If you have a severe headache. Your healthcare provider may change
  • The instructions for taking Aspirin and Extended-Release Dipyridamole Capsules.Swallow Aspirin and Extended-Release Dipyridamole Capsules whole. Do not crush or chew the capsules.You can take Aspirin and Extended-Release Dipyridamole Capsules with or without food.If you miss a dose, take
  • Your next dose at the usual time. Do not take two doses at one time.If you take more Aspirin and Extended-Release Dipyridamole Capsules (overdose) than prescribed, call
  • Your healthcare provider or Poison Control Center, or get emergency
  • Help right away.Symptoms of an overdose
  • Of Aspirin and Extended-Release Dipyridamole Capsules include:a warm feeling or flushingsweatingrestlessnessweakness or dizzinessa fast heart rateringing in the ears What should I avoid
  • While using Aspirin and Extended-Release Dipyridamole Capsules?heavy alcohol use. People
  • Who drink three or more alcoholic drinks every day have a higher risk
  • Of bleeding during treatment with Aspirin and Extended-Release Dipyridamole Capsules, because it contains aspirin.What are the possible
  • Side effects of Aspirin and Extended-Release Dipyridamole Capsules?Aspirin and Extended-Release Dipyridamole Capsules may cause serious side effects,
  • Including:increased risk of bleeding. You may bleed more easily during Aspirin and Extended-Release Dipyridamole Capsules treatment, and it may
  • Take longer than usual for bleeding to stop. This can include:bleeding into your brain (intracranial hemorrhage). This can be a medical emergency. Get medical help right away
  • If you have any of these symptoms while taking Aspirin and Extended-Release Dipyridamole Capsules:severe headache with drowsinessconfusion or memory changepass out (become unconscious)bleeding in your stomach or intestine.stomach painheartburn or nauseavomiting blood or vomit looks like "coffee grounds"red or bloody stools black stools that look like tarnew or worsening chest pain in some people
  • With heart disease. Tell your healthcare provider
  • If you have new chest pain or have any change in your chest pain during
  • Treatment with Aspirin and Extended-Release Dipyridamole Capsules.liver problems, including
  • Increased liver function tests and liver failure. Tell your healthcare
  • Provider if you have any of these symptoms of a liver problem while
  • Taking Aspirin and Extended-Release Dipyridamole Capsules:loss of appetitepale colored stoolstomach area (abdomen) painyellowing of your skin or whites of your eyesdark urineitching Call your healthcare provider right
  • Away if you have any of the symptoms listed above.The most common side effects of Aspirin and Extended-Release Dipyridamole Capsules include:headacheupset stomachdiarrheaThese are not all the possible side
  • Effects of Aspirin and Extended-Release Dipyridamole Capsules. Tell your healthcare provider or pharmacist if
  • You have any side effect that bothers you or that does not go away.Call your healthcare provider for medical
  • Advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.How should I store Aspirin and Extended-Release Dipyridamole Capsules?Store Aspirin and Extended-Release Dipyridamole Capsules at room temperature 68°F to 77°F (20°C to 25°C).Keep Aspirin and Extended-Release Dipyridamole Capsules dry.Keep Aspirin and Extended-Release Dipyridamole Capsules and
  • All medicines out of the reach of children.General information about
  • Aspirin and Extended-Release Dipyridamole Capsules Medicines
  • Are sometimes prescribed for purposes other than those listed in the
  • Patient Information. Do not use Aspirin and Extended-Release Dipyridamole Capsules for a condition for which
  • It was not prescribed. Do not give Aspirin and Extended-Release Dipyridamole Capsules to other people, even
  • If they have the same symptoms that you have. It may harm them.This Patient Information summarizes the
  • Most important information about Aspirin and Extended-Release Dipyridamole Capsules. If you would like more
  • Information, talk with your healthcare provider. You can ask your
  • Pharmacist or healthcare provider for information about Aspirin and Extended-Release Dipyridamole Capsules that
  • Is written for health professionals.For more information, call Lannett Company, Inc. at 1-844-834-0530. What are the ingredients in Aspirin and Extended-Release Dipyridamole Capsules?Active Ingredients: dipyridamole in an extended-release form and aspirinInactive Ingredients: hydrogenated castor oil, hypromellose 2910, hypromellose phthalate, methacrylic acid copolymer, microcrystalline cellulose, povidone, simethicone emulsion, starch, talc, tartaric acid and triacetin. The imprinting ink also contains ammonium hydroxide, n-butyl alcohol, black iron oxide, isopropyl alcohol, propylene glycol and shellac glaze. Each capsule shell contains gelatin, red iron oxide and yellow iron oxide and titanium dioxide.

* Please review the disclaimer below.

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