Clopidogrel

Clopidogrel is an antiplatelet medicine or a blood thinner that helps to prevent the formation of harmful blood clots in your blood vessels. This helps to lower the chances of you getting a heart attack or stroke. It is a widely used medicine for heart protection. Clopidogrel is prescribed to people at high risk of heart disease. This includes people with peripheral vascular disease (blood circulation problems due to narrowing of blood vessels), recent heart attack or stroke, irregular heartbeats, and those who have undergone certain heart procedures like stenting. It is also used in combination with some other medicines for the treatment of heart attack and some types of heart-related chest pain (unstable angina).

Clopidogrel is an antiplatelet medication. It works by preventing platelets from sticking together, thereby decreasing the formation of harmful blood clots. This lowers the chance of heart attack or stroke.

• Acute Coronary Syndrome (ACS) - Unstable Angina/Non-ST-Elevation MI (NSTEMI)
• Acute ST-Elevation MI (STEMI)
• Recent MI, Recent Stroke, or Established Peripheral Arterial Disease

Clopidogrel is a prodrug. It inhibits platelet activation and aggregation through the irreversible binding of its active metabolite to the P2Y12 class of ADP receptors on platelets. Dose-dependent inhibition of platelet aggregation can be seen 2 hours after single oral doses. Repeated doses of 75 mg per day inhibit ADP-induced platelet aggregation on the first day, and inhibition reaches steady state between Day 3 and Day 7.

Clopidogrel inhibits adenosine diphosphate (ADP) from binding to its receptor sites on the platelets and subsequent activation of glycoprotein GP IIb/IIIa complex, thus preventing fibrinogen binding, platelet adhesion and aggregation.

Adult Dose (Oral):

• Prophylaxis of thromboembolic disorders, Recent MI/Stroke/Peripheral Arterial Disease, Coronary Artery Disease: 75 mg once daily.
• Acute Coronary Syndrome (with loading dose): Initial 300 mg (loading dose), then 75 mg once daily (up to 12 months).
• STEMI (75 years): 75 mg once daily for 14 days (without loading dose).

Pediatric Dose: Safety and efficacy not established.

Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Clopidogrel may be taken with or without food, but it is better to take it at a fixed time.

If you miss a dose of Clopidogrel, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular schedule. Do not double the dose.

Common Side Effects:

• Bleeding (bruising, nosebleeds, blood in urine/stool, heavy periods)
• Diarrhea
• Gastrointestinal discomfort
• Skin reactions

Rare Side Effects: Acquired hemophilia, anemia, angioedema, arthralgia, arthritis, bone marrow disorders, Thrombotic Thrombocytopenic Purpura (TTP).

• [SAFE] Clopidogrel does not usually affect your ability to drive.
• For best results, take it at the same time every day.
• Clopidogrel increases your risk of bleeding. Be careful while shaving, using sharp objects, or cutting fingernails or toenails.
• Do not discontinue without consulting your doctor (increases risk of heart attack/stroke).
• May need to be stopped temporarily before surgery or dental treatment (5 days prior).
• Reduced antiplatelet activity in CYP2C19 poor metabolizers or patients taking omeprazole/esomeprazole.

• Hypersensitivity
• Active pathological bleeding (peptic ulcer, intracranial hemorrhage)

NSAIDs, warfarin, SSRIs/SNRIs: Increases risk of bleeding. CYP2C19 inhibitors (omeprazole or esomeprazole): Avoid concomitant use. Repaglinide: Avoid concomitant use (increases plasma concentrations).

[CAUTION] Caution is advised when consuming alcohol with Clopidogrel. Please consult your doctor.

[SAFE IF PRESCRIBED] Clopidogrel is generally considered safe to use during pregnancy. Animal studies have shown low or no adverse effects to the developing baby; however, there are limited human studies. Pregnancy Category B.

[SAFE IF PRESCRIBED] Clopidogrel is probably safe to use during breastfeeding. Limited human data suggests that the drug does not represent any significant risk to the baby.

Safety and effectiveness in pediatric patients have not been established.

No dosage adjustment is necessary in elderly patients.

[CONSULT YOUR DOCTOR] There is limited information available on the use of Clopidogrel in patients with kidney disease. Dose adjustment not necessary.

[SAFE IF PRESCRIBED] Clopidogrel is safe to use in patients with liver disease. No dose adjustment of Clopidogrel is recommended.

Overdose following clopidogrel administration may lead to bleeding complications. Platelet transfusion may restore clotting ability.

Keep below 30°C temperature in a dry place. Protected from light. Do not freeze. Keep out of reach of children.

Clopidogrel