Clopidogrel

Generic Name: Clopidogrel

Clopidogrel is used to prevent heart attacks and strokes in persons with heart disease(recent heart attack), recent stroke, or blood circulation disease (peripheral vascular disease).

Clopidogrel is also used with aspirin to treat new/worsening chest pain (new heart attack, unstable angina) and to keep blood vessels open and prevent blood clots after certain procedures (such as cardiac stent).

Clopidogrel works by blocking platelets from sticking together and prevents them from forming harmful clots. It is an antiplatelet drug. It helps keep blood flowing smoothly in your body.

Clopidogrel is available under the following different brand names: Plavix.

Dosages of Clopidogrel:

Dosage Forms and Strengths

Tablet

  • 75 mg
  • 300 mg

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Clopidogrel is a prodrug, which is activated in two steps, first by CYP2C19, CYP1A2 and CYP2B6, then by CYP2C19, CYP2C9, CYP2B6 and CYP3A. The active metabolite then specifically and irreversibly inhibits the P2Y12 subtype of ADP receptor, which is important in activation of platelets and eventual cross-linking by the protein fibrin. Platelet inhibition can be demonstrated two hours after a single dose of oral clopidogrel, but the onset of action is slow, so a loading dose of either 600 or 300 mg is administered when a rapid effect is needed.

Clopidogrel is used to prevent heart attack and stroke in people who are at high risk of these events, including those with a history of myocardial infarction and other forms of acute coronary syndrome, stroke, and those with peripheral artery disease.

Treatment with clopidogrel or a related drug is recommended by the American Heart Association and the American College of Cardiology for people who:

  • Present for treatment with a myocardial infarction with ST-elevation including
  • A loading dose given in advance of percutaneous coronary intervention (PCI), followed by a full year of treatment for those receiving a vascular stent
  • A loading dose given in advance of fibrinolytic therapy, continued for at least 14 days
  • Present for treatment of a non-ST elevation myocardial infarction or unstable angina
  • Including a loading dose and maintenance therapy in those receiving PCI and unable to tolerate aspirin therapy
  • Maintenance therapy for up to 12 months in those at medium to high risk for which a noninvasive treatment strategy is chosen
  • In those with stable ischemic heart disease, treatment with clopidogrel is described as a "reasonable" option for monotherapy in those who cannot tolerate aspirin, as is treatment with clopidogrel in combination with aspirin in certain high risk patients.

It is also used, along with acetylsalicylic acid (ASA, aspirin), for the prevention of thrombosis after placement of a coronary stent or as an alternative antiplatelet drug for people intolerant to aspirin.

Clopidogrel's benefit is primarily in those who smoke cigarettes (25% benefit), with only slight (8%) benefit in those who do not smoke cigarettes.

Consensus-based therapeutic guidelines also recommend the use of clopidogrel rather than ASA for antiplatelet therapy in people with a history of gastric ulceration, as inhibition of the synthesis of prostaglandins by ASA can exacerbate this condition. In people with healed ASA-induced ulcers, however, those receiving ASA plus the proton pump inhibitor esomeprazole had a lower incidence of recurrent ulcer bleeding than those receiving clopidogrel. However, prophylaxis with proton pump inhibitors along with clopidogrel following acute coronary syndrome may increase adverse cardiac outcomes, possibly due to inhibition of CYP2C19, which is required for the conversion of clopidogrel to its active form. The European Medicines Agency has issued a public statement on a possible interaction between clopidogrel and proton pump inhibitors. However, several cardiologists have voiced concern that the studies on which these warnings are based have many limitations and that it is not certain whether an interaction between clopidogrel and proton pump inhibitors is real.

Side effects associated with use of Clopidogrel, include the following:

  • Upper respiratory tract infection
  • Chest pain
  • Headache
  • Flulike syndrome
  • Joint pain
  • Pain
  • Dizziness
  • Diarrhea
  • Rash
  • Runny or stuffy nose
  • Depression
  • Urinary tract infection
  • Increased bleeding
  • Nosebleeds
  • Itching
  • Bruising

Less common side effects of clopidogrel include:

  • Severely low white blood cell counts (neutropenia)
  • Thrombotic thrombocytopenic purpura
  • Acute liver failure
  • Aplastic anemia
  • Low blood pressure (hypotension)
  • Hepatitis
  • Muscle pain
  • Eczema
  • Skin redness
  • Agranulocytosis

Postmarketing side effects of clopidogrel reported include:

  • Blood and lymphatic system disorders: Agranulocytosis, aplastic anemia/pancytopenia, thrombotic thrombocytopenic purpura (TTP), acquired hemophilia A
  • Eye disorders: Eye (conjunctival, ocular, retinal) bleeding
  • Gastrointestinal disorders: Gastrointestinal and retroperitoneal hemorrhage with fatal outcome, colitis (including ulcerative or lymphocytic colitis), pancreatitis, stomatitis, gastric/duodenal ulcer, diarrhea
  • General disorders and administration site condition: Fever, hemorrhage of operative wound
  • Hepato-biliary disorders: Acute liver failure, hepatitis (non-infectious), abnormal liver function test
  • Immune system disorders: Hypersensitivity reactions, anaphylactoid reactions, serum sickness
  • Musculoskeletal, connective tissue and bone disorders: Musculoskeletal bleeding, muscle pain, joint pain, arthritis
  • Nervous system disorders: Taste disorders, fatal intracranial bleeding, headache
  • Psychiatric disorders: Confusion, hallucinations
  • Respiratory, thoracic and mediastinal disorders: Bronchospasm, interstitial pneumonitis, respiratory tract bleeding, eosinophilic pneumonia
  • Renal and urinary disorders: Increased creatinine levels
  • Skin and subcutaneous tissue disorders: Maculopapular, erythematous, or exfoliative rash, urticaria, bullous dermatitis, eczema, toxic epidermal necrolysis, Stevens-Johnson syndrome, angioedema, drug-induced hypersensitivity syndrome, drug rash with eosinophilia and systemic symptoms (DRESS), erythema multiforme, skin bleeding, lichen planus, generalized itching, acute generalized exanthematous pustulosis (AGEP)
  • Vascular disorders: Vasculitis, hypotension

Acute Coronary Syndrome

Unstable angina, non-ST-segment elevation heart attack (myocardial infarction [MI]) (NSTEMI): 300 mg loading dose; initiating therapy without a loading dose will delay establishment of antiplatelet effect by several days; following the loading dose, administer 75 mg/day orally for up to 12 months; may administer beyond 12 months if used in combination with aspirin (75-100 mg/day); long-term combination therapy with aspirin, following stent placement, is individualized depending on how a patient tolerates long-term dual antiplatelet therapy (DAPT), whether they have stable coronary artery disease, and do NOT have risk factors (e.g., transient ischemic attack [TIA] or stroke, age over 75 years, bleeding risk, low body weight, concurrent medications)

ST-segment elevation myocardial infarction (MI) (STEMI): 75 mg/day orally in combination with aspirin 162-325 mg/day and then 81-162 mg/day

Age under 75 years

  • 300 mg loading dose followed by 75 mg for 14 days up to 12 months (if no bleeding)
  • Concomitant therapy with aspirin: Administer in combination with aspirin 75-325 mg once/day with or without thrombolytics

Age over 75 years

  • No loading dose
  • 75 mg for 14 days up to 12 months (if no bleeding)

Recent heart attack (Myocardial Infarction [MI]), Stroke, or Established Peripheral Arterial Disease

  • 75 mg orally once/day without a loading dose; recommended as alternative to aspirin or concomitantly with aspirin if patient not at increased risk for bleeding but at high risk for cardiovascular disease

Coronary Artery Disease

  • 75 mg orally once/day

Cardioembolic Stroke

  • Prophylaxis if patient not candidate for oral anticoagulation
  • 75 mg/day orally

Dosing Modifications

  • Renal impairment: Dose adjustment not necessary
  • Hepatic impairment: Use caution; experience limited

Dosing Considerations

  • CYP2C19 poor metabolizers associated with diminished antiplatelet response to clopidogrel; although higher-dose regimen (600 mg loading dose followed by 150 mg once daily) in poor metabolizers increases antiplatelet response, no appropriate dosing regimen for poor metabolizers has been established in clinical outcome trials
  • Not recommended for pediatric use

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

Severe interactions of clopidogrel include:

  • ombitasvir/paritaprevir/ritonavir, and dasabuvir

Clopidogrel has serious interactions with at least 42 different drugs.

Clopidogrel has moderate interactions with at least 141 different drugs.

Mild Interactions of clopidogrel include:

  • aspirin rectal
  • devil's claw
  • ethotoin
  • fluvastatin
  • fosphenytoin
  • ginger
  • ginkgo biloba
  • horse chestnut seed
  • ibuprofen/famotidine
  • phenytoin
  • salicylates (non-ASA)
  • tolbutamide
  • torsemide
  • verteporfin

It is not known whether clopidogrel is excreted in human milk; because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants from clopidogrel, a decision should be made whether to discontinue nursing or to discontinue drug, taking into account importance of drug to mother.

  • Clopidogrel's antiplatelet activity is dependent on conversion to an active metabolite by the cytochrome P450 (CYP) system, principally CYP2C19
  • Tests are available to identify patients who are CYP2C19 poor metabolizers
  • Consider use of another platelet P2Y12 inhibitor in patients identified as CYP2C19 poor metabolizers
  • This medication contains clopidogrel. Do not take Plavix if you are allergic to clopidogrel or any ingredients contained in this drug
  • Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately

All Relative Medicines

CLOPIDOGREL + ASPIRIN PREVA-AS

(10 Tablet) of 75+75mg
Rs. 28.00 INR
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CLOPIDOGREL + ASPIRIN CLOPIVAS AP

(10 Tablet) of 75+150mg
Rs. 30.10 INR
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CLOPIDOGREL PLAVIX

(14 Tablet) of 75mg
Rs. 1530.00 INR
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CLOPIDOGREL PREVA

(10 Tablet) of 75mg
Rs. 39.75 INR
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CLOPIDOGREL PLAGRIL

(10 Tablet) of 75mg
Rs. 47.50 INR
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CLOPIDOGREL + ASPIRIN STROMIX A

(10 Tablet) of 75+150mg
Rs. 91.85 INR
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CLOPIDOGREL + ASPIRIN CLOPIRAD

(10 Tablet) of 75+75mg
Rs. 27.65 INR
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CLOPIDOGREL + ASPIRIN CLOPIRAD

(10 Tablet) of 75+150mg
Rs. 27.91 INR
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CLOPIDOGREL + ASPIRIN SYNPLATT

(10 Capsule) of 75+75mg
Rs. 27.00 INR
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CLOPIDOGREL CLOPIVAS

(15 Tablet) of 75mg
Rs. 67.00 INR
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CLOPIDOGREL NOPLAQ

(10 Tablet) of 75mg
Rs. 55.00 INR
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CLOPIDOGREL + ASPIRIN CLOPIGREL A

(10 Tablet) of 75+75mg
Rs. 157.10 INR
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CLOPIDOGREL STROMIX

(10 Tablet) of 75mg
Rs. 89.65 INR
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CLOPIDOGREL CLAVIX

(15 Tablet) of 75mg
Rs. 92.63 INR
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CLOPIDOGREL + ASPIRIN DOSPIN

(10 Tablet) of 75+150mg
Rs. INR
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CLOPIDOGREL + ASPIRIN DEPLATT A

(10 Tablet) of 75+150mg
Rs. 28.68 INR
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CLOPIDOGREL + ASPIRIN DEPLATT A

(10 Tablet) of 75+75mg
Rs. 28.40 INR
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CLOPIDOGREL + ASPIRIN CLOPIVAS AP

(10 Tablet) of 75+75mg
Rs. 29.83 INR
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CLOPIDOGREL DEPLATT

(10 Tablet) of 75mg
Rs. 47.00 INR
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CLOPIDOGREL + ASPIRIN STROMIX A

(10 Tablet) of 75+75mg
Rs. 87.45 INR
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CLOPIDOGREL + ASPIRIN CLOPIGREL A

(10 Tablet) of 75+150mg
Rs. 157.10 INR
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CLOPIDOGREL CLOPIVAS

(2 Tablet) of 300mg
Rs. INR
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CLOPIDOGREL + ASPIRIN SYNPLATT

(10 Capsule) of 75+150mg
Rs. 27.50 INR
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CLOPIDOGREL + ASPIRIN COMBIPLET

(10 Capsule) of 75+75mg
Rs. 29.71 INR
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CLOPIDOGREL + ASPIRIN DOSPIN

(10 Tablet) of 75+75mg
Rs. 25.50 INR
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CLOPIDOGREL KLOV

(15 Tablet) of 75mg
Rs. 67.50 INR
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CLOPIDOGREL + ASPIRIN THROMBOSPRIN

(10 Capsule) of 75+75mg
Rs. 29.71 INR
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CLOPIDOGREL CLOPIRAD

(10 Tablet) of 75mg
Rs. 27.00 INR
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CLOPIDOGREL + ASPIRIN PREVA-AS

(10 Tablet) of 75+150mg
Rs. INR
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