April 29, 2017
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Clopidogrel

Medical and Pharmacy Editor:

Brand Name: Plavix

Generic Name: clopidogrel

Drug Class: Antiplatelet Agents, Cardiovascular; Antiplatelet Agents, Hematologic

What Is Clopidogrel and How Does It Work?

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

Dosage Considerations – Should be Given as Follows:

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
Medically Reviewed by a Doctor on 4/17/2017



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