Questions about Atrial Fibrillation? Get answers from our expert.

clopidogrel

Pronunciation

Generic Name: clopidogrel (kloe PID oh grel)
Brand Name: Plavix

What is clopidogrel?

Clopidogrel keeps the platelets in your blood from coagulating (clotting) to prevent unwanted blood clots that can occur with certain heart or blood vessel conditions.

Clopidogrel is used to prevent blood clots after a recent heart attack or stroke, and in people with certain disorders of the heart or blood vessels.

Clopidogrel may also be used for purposes not listed in this medication guide.

What is the most important information I should know about clopidogrel?

Your doctor will perform blood tests to make sure you do not have certain genetic conditions that would prevent you from safely using clopidogrel.

You should not use this medicine if you have any active bleeding such as a stomach ulcer or bleeding in the brain (such as from a head injury).

Some medicines can interact with clopidogrel and should not be used at the same time. Your doctor may need to change your treatment plan if you also take other medicines, especially certain stomach acid reducers (esomeprazole, omeprazole, Nexium, Prilosec).

What should I discuss with my healthcare provider before taking clopidogrel?

You should not use this medicine if you are allergic to clopidogrel, or if you have any active bleeding such as a stomach ulcer or bleeding in the brain (such as from a head injury).

Some medicines can interact with clopidogrel and should not be used at the same time. Your doctor may need to change your treatment plan if you also take other medicines, especially certain stomach acid reducers (esomeprazole, omeprazole, Nexium, Prilosec).

To make sure clopidogrel is safe for you, tell your doctor if you have:

  • a bleeding or blood clotting disorder, such as TTP (thrombocytopenic purpura) or hemophilia;

  • a history of stroke, including TIA ("mini-stroke");

  • a stomach ulcer or ulcerative colitis;

  • kidney disease; or

  • if you are allergic to medicines like clopidogrel, such as prasugrel, ticagrelor, or ticlopidine.

FDA pregnancy category B. This medication is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

It is not known whether clopidogrel passes into breast milk or if it could harm a nursing baby. You should not breast-feed while using this medicine.

How should I take clopidogrel?

Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Clopidogrel can be taken with or without food.

Because clopidogrel keeps your blood from clotting, it can also make it easier for you to bleed, even from a minor injury. Contact your doctor or seek emergency medical attention if you have bleeding that will not stop.

If you need surgery or dental work, tell the surgeon or dentist ahead of time that you are using clopidogrel. You may need to stop using the medicine for at least 5 days before having surgery, to prevent excessive bleeding. Follow your doctor's instructions and start taking clopidogrel again as soon as possible.

You should not stop using this medicine suddenly. Use clopidogrel regularly even if you feel fine or have no symptoms. Get your prescription refilled before you run out of medicine completely.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking clopidogrel?

Avoid activities that may increase your risk of bleeding or injury. Use extra care to prevent bleeding while shaving or brushing your teeth.

Avoid drinking alcohol. It may increase your risk of bleeding in your stomach or intestines.

Clopidogrel side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using clopidogrel and call your doctor at once if you have any of these serious side effects:

  • nosebleed or other bleeding that will not stop;

  • bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds;

  • pale skin, weakness, fever, or jaundice (yellowing of the skin or eyes);

  • easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), purple or red pinpoint spots under your skin;

  • heart attack symptoms--chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating; or

  • signs of a stroke--sudden numbness or weakness (especially on one side of the body), sudden severe headache, slurred speech, problems with vision or balance.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Clopidogrel Dosing Information

Usual Adult Dose for Ischemic Stroke:

75 mg orally once a day with or without food.

Aspirin therapy should be initiated and continued in combination with clopidogrel.

Usual Adult Dose for Myocardial Infarction:

75 mg orally once a day with or without food.

Aspirin therapy should be initiated and continued in combination with clopidogrel.

Usual Adult Dose for Acute Coronary Syndrome -- Prophylaxis:

75 mg orally once a day with or without food.

Aspirin therapy should be initiated and continued in combination with clopidogrel.

Usual Adult Dose for Peripheral Arterial Disease:

75 mg orally once a day with or without food.

Aspirin therapy should be initiated and continued in combination with clopidogrel.

Usual Adult Dose for Acute Coronary Syndrome:

Unstable angina, non ST segment elevation myocardial infarction (UA/NSTEMI): Initial: 300 mg loading dose, followed by 75 mg once daily for at least 1 month and ideally up to 12 months (in combination with aspirin 75 to 162 mg once daily indefinitely).
ST segment elevation acute myocardial infarction (STEMI): 75 mg once daily (in combination with aspirin 162 to 325 mg initially, followed by 81 to 162 mg/day); Note: The CLARITY TIMI 28 study used a 300 mg loading dose of clopidogrel (with thrombolysis) demonstrating an improvement in the patency rate of the infarct related artery and reduction in ischemic complications. The duration of therapy was less than 28 days (usually until hospital discharge) unless non primary percutaneous coronary intervention (PCI) was performed.

Usual Adult Dose for Percutaneous Coronary Intervention:

Percutaneous coronary intervention (PCI) for UA/NSTEMI or STEMI:
Loading dose: 300 to 600 mg (600 mg may be preferred for early invasive strategy with UA/NSTEMI) given as early as possible before or at the time of PCI followed by 75 mg once daily. Note: If an initial loading dose of 300 mg was given prior to PCI, a supplemental loading dose of 300 mg (total loading dose: 600 mg) may be administered. For patients with UA/NSTEMI, it has been recommended that the loading dose be given at least 2 hours (or 24 hours in patients unable to take aspirin) prior to PCI.

Higher vs standard maintenance dosing: May consider a maintenance dose of 150 mg once daily for 6 days, then 75 mg once daily thereafter in patients not at high risk for bleeding; however, in another study, in patients with high on treatment platelet reactivity, the use of 150 mg once daily for 6 months did not demonstrate a difference in 6 month incidence of death from cardiovascular causes, nonfatal MI, or stent thrombosis compared to standard dose therapy (Price, 2011).

Duration of clopidogrel (in combination with aspirin) after stent placement: Premature interruption of therapy may result in stent thrombosis with subsequent fatal and nonfatal MI. With STEMI, clopidogrel for at least 12 months regardless of stent type (either bare metal or drug eluting stent) is recommended. With UA/NSTEMI, at least 12 months of clopidogrel is recommended in patients receiving a drug eluting stent (DES) unless the risk of bleeding outweighs the benefits. For bare metal stent (BMS) placement, at least 1 month and ideally up to 12 months duration is recommended unless the risk of bleeding outweighs the benefits; then, a minimum of 2 weeks is recommended. In either setting, a duration greater than 15 months may be considered in patients with DES placement. For patients without ongoing ACS, clopidogrel should be continued for at least 1 month (for BMS) or at least 12 months (for DES).

Usual Geriatric Dose for Acute Coronary Syndrome:

The American College of Chest Physicians recommends:

Patients over 75 years: 75 mg once daily for up to 28 days (with or without thrombolysis)

Usual Pediatric Dose for Platelet Aggregation Inhibition:

Note: Safety and efficacy have not been established in pediatric patients; optimal dose is not known; limited dosing information is available; further pediatric studies are needed.

Neonates and Infants up to 2 years: 0.2 mg/kg once daily was found to achieve a mean inhibition of platelet aggregation similar to adults receiving the recommended dose. This dose comes from the PICOLO study which included pediatric patients with a systemic to pulmonary artery shunt, intracardiac or intravascular stent, Kawasaki disease, or arterial graft; 79% of patients received concomitant aspirin; patients less than 2 kg and those born at less than 35 weeks gestational age were excluded.

Children over 2 years of age: Optimal dose is not established; some centers use the following: Initial dose: 1 mg/kg once daily; titrate to response; in general, do not exceed adult dose.

What other drugs will affect clopidogrel?

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 clopidogrel.

Tell your doctor about all medicines you use, and those you start or stop using during your treatment with clopidogrel, especially:

  • a blood thinner (warfarin, Coumadin, Jantoven);

  • NSAIDs (nonsteroidal-steroidal anti-inflammatory drugs)--aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others; or

  • an antidepressant--citalopram, desvenlafaxine, duloxetine, escitalopram, fluoxetine (Prozac), fluvoxamine, milnacipran, paroxetine, sertraline (Zoloft), trazodone, venlafaxine, vilazodone, and others.

This list is not complete. Other drugs may interact with clopidogrel, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Where can I get more information?

  • Your pharmacist can provide more information about clopidogrel.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 12.01. Revision Date: 2014-02-04, 9:37:20 PM.

Hide
(web2)