Names and pronunciation
(klo-pid′oh-grel) Plavix
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Individual generic drug information
Extracted information for clopidogrel only.
(klo-pid′oh-grel) Plavix
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Func. class.: Platelet aggregation inhibitor
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Chem. class.: Thienopyridine derivative
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Do not confuse: Plavix/Paxil
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ACTION: Inhibits ADP-induced plate- let aggregation
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USES: Reducing the risk of stroke, MI, vascular death, peripheral arterial dis- ease in high-risk patients, acute coronary syndrome, transient ischemic attack (TIA), unstable angina
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Extracted information for clopidogrel only.
CONTRAINDICATIONS: Hyper- sensitivity, active bleeding Precautions: Pregnancy, breastfeeding, children, previous hepatic disease, increased bleeding risk, neutropenia, agranulocytosis, renal disease, Asian/ Black/Caucasian patients
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Black Box Warning: CYP2C19 allele (poor metabolizers) Black Box Warning: Avoid use with CYP2C19 inhibitors (omeprazole, esomeprazole) Increase: bleeding risk—anticoagulants, aspirin, NSAIDs, abciximab, eptifibatide, tirofiban, thrombolytics, ticlopidine, SSRIs, treprostinil, rifampin, SNRIs, prasugrel, monitor closely Increase: action of some NSAIDs, phenyt- oin, TOLBUTamide, tamoxifen, torsemide, fluvastatin, warfarin, monitor closely Decrease: clopidogrel effect—proton pump inhibitors (PPIs) Decrease: CYP3A4 inhibitors/substrates— atorvastatin, simvastatin, cerivastatin Drug/Herb Increase: clopidogrel effect—feverfew, fish oil, omega-3 fatty acid, garlic, ginger, ginkgo biloba, green tea, horse chestnut Decrease: clopidogrel effect—bilberry, saw palmetto Drug/Lab Test Increase: AST, ALT, bilirubin, uric acid, total cholesterol, nonprotein nitrogen (NPN) Black Box Warning: CYP2C19 al- lele (poor metabolizers): consider us- ing another antiplatelet product; higher CV reaction occurs after acute coronary syndrome or PCI; tests are available to determine CYP2C19 allele • Hepatic studies: AST, ALT, bilirubin, creatinine (long-term therapy) • Blood studies: CBC, differential, Hct, HB, PT, cholesterol (long-term therapy); thrombocytopenia, neutropenia are rare • Hypersensitivity: rash, angioedema may occur
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SIDE EFFECTS CNS: Headache, dizziness, depression CV: Edema, hypertension, chest pain GI: Diarrhea, constipation, GI discomfort HEMA: Bleeding (major/minor from any site), neutropenia, aplastic anemia, agranulocytosis, thrombotic thrombocyto- penic purpura INTEG: Rash, pruritus, anaphylaxis MISC: Fatigue, intracranial hemorrhage, toxic epidermal necrolysis, Stevens- Johnson syndrome, flulike syndrome MS: Arthralgia RESP: Bronchospasm
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INTERACTIONS
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Extracted information for clopidogrel only.
DOSAGE AND ROUTES Recent MI, stroke, peripheral arterial disease, TIA • Adult: PO 75 mg/day with/without as- pirin Acute MI (ST-segment elevation, MI) • Adult: PO 75 mg/day with aspirin 75- 325 mg/day; with or without loading dose or thrombolytics; those >75 yr no loading dose should be given; continue this product for 2 wk to <1 yr with aspi- rin 81 mg indefinitely Acute coronary syndrome • Adult: PO loading dose 300 mg, then 75 mg/day with aspirin
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Available forms: Tablets 75, 300 mg
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Administer: • Without regard to food • Should be discontinued 5 days prior to elective surgery if an antiplatelet action is not desired
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Extracted information for clopidogrel only.
Assess: • Thrombotic/thrombocytic purpura: fe- ver, thrombocytopenia, hemolytic anemia, neurologic changes, treat immediately
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Evaluate: • Therapeutic response: absence of stroke, MI
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • That blood work will be necessary dur- ing treatment (CBC, LFTs) • To report any unusual bruising, bleed- ing to prescriber; that it may take longer to stop bleeding • To take without regard to food • To tell all health care providers that clopidogrel is being used; may be held for 5 days before surgery, restart as soon as possible • Hypersensitivity: To report immedi- ately rash, pruritus • Pregnancy/breastfeeding: to notify provider if pregnancy is planned or sus- pected or if breastfeeding; do not breast- feed, use cautiously in pregnancy
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Extracted information for clopidogrel only.
PHARMACOKINETICS Rapidly absorbed; metabolized by liver (CYP3A4, CYP2B6, CYP1A2, CYP2C8); excreted in urine, feces; half-life 6 hr; protein binding 95%; effect on platelets C after 3-7 days
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Filter the extracted dose blocks for this individual drug.
Recent MI, stroke, peripheral arterial disease, TIA
• Adult: PO 75 mg/day with/without as- pirin Acute MI (ST-segment elevation, MI)
Candidate age grouping · source page 307
Recent MI, stroke, peripheral arterial disease, TIA
• Adult: PO 75 mg/day with aspirin 75- 325 mg/day; with or without loading dose or thrombolytics; those >75 yr no loading dose should be given; continue this product for 2 wk to <1 yr with aspi- rin 81 mg indefinitely Acute coronary syndrome
Candidate age grouping · source page 307
Recent MI, stroke, peripheral arterial disease, TIA
• Adult: PO loading dose 300 mg, then 75 mg/day with aspirin
Candidate age grouping · source page 307