II. Indications: Prevention of Thrombotic Events
- See Platelet ADP Receptor Antagonist
- See Antiplatelet Therapy for Vascular Disease
- Cerebrovascular Accident Prevention
- Coronary Artery Disease Prevention (especially if Aspirin Allergy)
- Post-ST Elevation MI (with or without reperfusion)
III. Contraindications
- Active Bleeding
IV. Mechanism
V. Background
- Clopidogrel is generic as of May 2012
VI. Dosing: Clopidogrel (Plavix)
- Standard dosing
- Plavix 75 mg orally daily
- Acute Myocardial Infarction
- Loading dose: Plavix 300 mg (if age <75 years)
- Then initiate standard 75 mg daily Plavix dose with Aspirin 81 mg
- Impending Percutaneous Coronary Intervention (PCI)
- Plavix 600 mg orally once
- Then initiate standard 75 mg daily Plavix dose after PCI
VII. Pharmacokinetics
VIII. Adverse Effects
-
Gastrointestinal Bleeding
- Clopidogrel is associated with less GI Bleeding than Aspirin or Prasugrel
- Consider as alternative if GI Bleeding occurs with Aspirin
- However, switching to Clopidogrel does not prevent recurrent GI Bleed
- GI Bleed occurs in 8% of those switched to Clopidogrel
- Consider adding Proton Pump Inhibitor (PPI) to Aspirin instead of Clopidogrel
IX. Safety
- Unknown safety in pregnancy
- Unknown safety in Lactation
X. Drug Interactions: General
- Agents that reduce Clopidogrel activity
- Opioids
- Strong CYP2C19 Inhibitors
- See Proton Pump Inhibitors related Drug Interactions as below
- Fluconazole, Ketaconazole or Voriconazole
- Fluoxetine, Fluvoxamine
- Agents whose levels are significantly increased by Clopidogrel
- Agents that increase bleeding risk when combined with Clopidogrel
XI. Drug Interactions: Proton Pump Inhibitors
- Agents that reduce conversion of Plavix to active metabolite (unclear clinical impact)
- Safe agents that do not appear to interact with Plavix
- Limit Proton Pump Inhibitors to high risk patients
- Prior GI Bleed
- Advanced age
- Concurrent Aspirin, NSAIDs, Corticosteroids, or Warfarin
- Application
- Avoid Proton Pump Inhibitors unless clear indication
- If a Proton Pump Inhibitor is needed
- Choose one that that does not interfere with Cloipidogrel (e.g. Lansoprazole)
- Consider agent that does not interact with PPIs such as Ticagrelor (Brilanta) in place of Clopidogrel
- Best data suggests no increased risk of cardiovascular events with PPI and Clopidogrel
- References
- (2013) Presc Lett 20(6): 36
- Mehta (2011) Clin Cardiol 34(9): 528-31 [PubMed]
XII. Management: Reversal
- See Platelet ADP Receptor Antagonist
- Stop 5 days before elective surgery
XIII. Resources
XIV. References
- Filler and Lovecchio (2017) Crit Dec Emerg Med 31(7): 24
- Switaj (2017) Am Fam Physician 95(4): 232-40 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| clopidogrel (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| CLOPIDOGREL 75 MG TABLET | Generic | $0.06 each |
| plavix (on 11/23/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| PLAVIX 75 MG TABLET | Generic | $0.06 each |