Clopidogrel

Clopidogrel Brand Name– Plavix

What is Clopidogrel

Clopidogrel is an oral P2Y₁₂ platelet inhibitor indicated to reduce the rate of myocardial infarction (MI) and stroke in patients with non-ST-elevation acute coronary syndromes (unstable angina and non-ST-elevation myocardial infarction [NSTEMI]), including patients who are to be managed medically and those who are to be managed with coronary revascularization, in patients with ST-elevation myocardial infarction (STEMI), and in patients with established peripheral arterial disease or with a history of recent MI or recent stroke.

Clopidogrel has been shown to reduce the rate of MI and stroke. It is intended for use in combination with aspirin in the management of patients with acute coronary syndromes.

A diminished antiplatelet effect for clopidogrel occurs in patients with 2 loss-of-function alleles of the CYP2C19 gene.

The antiplatelet activity effectiveness of clopidogrel is dependent on its conversion to an active metabolite by the cytochrome P450 (CYP) system, principally CYP2C19. At recommended doses, clopidogrel forms less of the active metabolite and has a reduced effect on platelet activity in patients who are homozygous for nonfunctional alleles of the CYP2C19 gene, known as CYP2C19 poor metabolizers.

Tests are available to identify patients who are CYP2C19 poor metabolizers, and use of another platelet P2Y12 inhibitor in patients identified as CYP2C19 poor metabolizers may be appropriate.

Clopidogrel increases the risk of bleeding. Thienopyridines, including clopidogrel, inhibit platelet aggregation for the lifetime of the platelet (7 to 10 days).

Because the half-life of clopidogrel’s active metabolite is short, it may be possible to restore hemostasis by administering exogenous platelets.

Indications

1. arterial thromboembolism prophylaxis
2. myocardial infarction prophylaxis
3. stroke prophylaxis
4. thrombosis prophylaxis

Side Effects

1. abdominal pain
2. acute generalized exanthematous pustulosis (AGEP)
3. agranulocytosis
4. anaphylactoid reactions
5. angioedema
6. aplastic anemia
7. arthralgia
8. bleeding
9. bronchospasm
10. colitis
11. confusion
12. constipation
13. diarrhea
14. dizziness
15. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
16. dysgeusia
17. dyspepsia
18. elevated hepatic enzymes
19. eosinophilic pneumonia
20. epistaxis
21. erythema multiforme
22. exfoliative dermatitis
23. fever
24. gastritis
25. GI bleeding
26. glomerulonephritis
27. hallucinations
28. headache
29. hematoma
30. hematuria
31. hepatic failure
32. hepatitis
33. hypertension
34. hypoglycemia
35. hypotension
36. insulin autoimmune syndrome
37. intracranial bleeding
38. maculopapular rash
39. melena
40. myalgia
41. nausea
42. ocular hemorrhage
43. pancreatitis
44. pancytopenia
45. peptic ulcer
46. peripheral edema
47. platelet dysfunction
48. pneumonitis
49. pruritus
50. purpura
51. rash
52. serum sickness
53. Stevens-Johnson syndrome
54. stomatitis
55. thrombotic thrombocytopenic purpura (TTP)
56. toxic epidermal necrolysis
57. urticaria
58. vasculitis
59. vertigo
60. vomiting

Monitoring Parameters

• CBC
• LFTs

Contraindications

• abrupt discontinuation
• bleeding
• breast-feeding
• children
• epidural anesthesia
• geriatric
• GI bleeding
• hepatic disease
• infants
• intracranial bleeding
• labor
• neonates
• obstetric delivery
• peptic ulcer disease
• poor metabolizers
• pregnancy
• renal disease
• renal failure
• renal impairment
• spinal anesthesia
• surgery
• thienopyridine hypersensitivity
• thrombotic thrombocytopenic purpura (TTP)
• trauma

Interactions

• Abciximab
• Acetaminophen; Aspirin, ASA; Caffeine
• Acetaminophen; Butalbital; Caffeine; Codeine
• Acetaminophen; Caffeine; Dihydrocodeine
• Acetaminophen; Codeine
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