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clopidogrel

clopidogrel

introduction

  • platelet aggregation inhibitor used in prophylaxis of thromboembolic disorders and with aspirin (acetylsalicylic acid) in acute coronary syndrome
  • marketed as Plavix and Iscover.
  • prodrug that requires hepatic metabolism (partly by CYP2C19) to become biologically active as a platelet inhibitor.

dosage

    • if age < 75yrs and not going for PCI, then 300 mg loading dose then 75 mg once daily (with aspirin)
    • if patient going to PCI:
      • 600mg loading dose as anti-platelet effects by 2hrs, compared with 300mg dose onset of effect is 6 hours.
      • ongoing dosing post PCI: 150mg daily for 7 days then 75mg/d for at least 12 months 1)
    • HOWEVER, giving clopidogrel MAY delay CABG if this is needed as it increases bleeding and mortality if given within 5 days of CABG!

contraindications include:

  • severe hepatic impairment
  • active pathological bleeding
  • lactation

precautions include:

  • monitor for bleeding
  • bleeding risk incl surgery, trauma, intraocular or GI lesion; elective surgery (may discontinue greater than or equal to 5 days prior if antiplatelet effect not desired);
  • coronary artery bypass (interrupt therapy greater than or equal to 5 days prior);
  • moderate hepatic, severe renal impairment;
  • acute ischaemic stroke (< 7 days);
  • elderly greater than or equal to 75 yrs;
  • pregnancy, children < 18 yrs

adverse reactions include

  • bleeding
  • blood dyscrasias
  • thrombotic thrombocytopenic purpura (very rare)
  • fatigue
  • rash incl bullous dermatitis

genetic polymorphisms and drug interactions

1)
Heart Foundation 2011 Guideline addendum
clopidogrel.txt · Last modified: 2014/12/16 16:22 (external edit)