1 tablet

18 cents

  • Treatment of acute coronary syndromes (especially post angioplasty when stents are deployed)

  • Prophylaxis of vascular ischaemic events (mainly in patients with coronary stents)

PO:
Apo-clopidogrel 75mg tablets (reddish brown)
Plavix 75mg tablets (pink)


ADULT DOSE
PO/NG:
300mg loading dose followed by 75mg daily
Plavix brand clopidogrel can be crushed, mixed with water and administered via a nasogastric tube.

PAEDIATRIC DOSE
PO:
1.5mg/kg daily

See PRECAUTIONS
Paediatric Use

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY
Dose as in normal renal function

Clopidogrel is a platelet aggregation inhibitor. It selectively inhibits the binding of adenosine diphosphate (ADP) to its platelet receptor and the subsequent ADP-mediated activation of the glycoprotein GPIIb/IIIa complex, thereby inhibiting platelet aggregation.

CONTRAINDICATIONS:

  • Hypersensitivity to clopidogrel

  • Active bleeding


WARNINGS
Thrombotic Thrombocytopenic Purpura (TTP)
TTP has been reported rarely following use of clopidogrel bisulfate, sometimes after a short exposure (<2 weeks). TTP is a serious condition that can be fatal and requires urgent treatment including plasmapheresis (plasma exchange). It is characterised by thrombocytopaenia, microangiopathic haemolytic anaemia (schistocytes [fragmented RBCs] seen on peripheral smear), neurological findings, renal dysfunction, and fever

PRECAUTIONS
General
Clopidogrel bisulfate prolongs the bleeding time and therefore should be used with caution in patients who may be at risk of increased bleeding from trauma, surgery, or other pathological conditions (particularly gastrointestinal and intraocular). If a patient is to undergo elective surgery and an antiplatelet effect is not desired, clopidogrel bisulfate should be discontinued 5 days prior to surgery.
In patients with recent TIA or stroke who are at high risk for recurrent ischemic events, the combination of aspirin and clopidogrel has not been shown to be more effective than clopidogrel alone, but the combination has been shown to increase major bleeding.
In CAPRIE, clopidogrel bisulfate was associated with a rate of gastrointestinal bleeding of 2.0% vs 2.7% on aspirin. In CURE, the incidence of major gastrointestinal bleeding was 1.3% vs 0.7% (clopidogrel bisulfate + aspirin versus placebo + aspirin, respectively). Clopidogrel bisulfate should be used with caution in patients who have lesions with a propensity to bleed (such as ulcers).

Laboratory Tests:
No tests in addition to routine ICU tests are indicated

Drug/Laboratory Test Interactions:
None noted

The risk of bleeding increases when clopidogrel is combined with other anticoagulants. Omeprazole and other PPIs decrease the antiplatelet effect of clopidogrel. It may be more appropriate to use Ranitidine as ulcer prophylaxis in patients on clopidogrel. If clopidogrel is used concomitantly with a PPI the dosages should be separated by 12 hours.

Body as a Whole:
Bleeding, anaphylaxis, angioedema, serum sickness, fatigue
Haematological:
TTP, leucopenia, eosinophilia
Gastrointestinal System:
Pancreatitis, stomatitis, colitis
Respiratory System:
Interstitial pneumonitis, bronchospasm
Skin:
Rash

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