Clopidogrel

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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
  • Acetaminophen; Hydrocodone
  • Acetaminophen; Oxycodone
  • Acetaminophen; Propoxyphene
  • Acetaminophen; Tramadol
  • Ado-Trastuzumab emtansine
  • Alfentanil
  • Aliskiren; Amlodipine
  • Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
  • Alogliptin; Pioglitazone
  • Altretamine
  • Aminolevulinic Acid
  • Amlodipine
  • Amlodipine; Atorvastatin
  • Amlodipine; Benazepril
  • Amlodipine; Celecoxib
  • Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
  • Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
  • Amlodipine; Olmesartan
  • Amlodipine; Telmisartan
  • Amlodipine; Valsartan
  • Amoxicillin; Clarithromycin; Omeprazole
  • Anagrelide
  • Antimetabolites
  • Antithrombin III
  • Antithymocyte Globulin
  • Apalutamide
  • Apixaban
  • Argatroban
  • Armodafinil
  • Arsenic Trioxide
  • Aspirin, ASA
  • Aspirin, ASA; Butalbital; Caffeine
  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Aspirin, ASA; Caffeine; Dihydrocodeine
  • Aspirin, ASA; Caffeine; Orphenadrine
  • Aspirin, ASA; Carisoprodol
  • Aspirin, ASA; Carisoprodol; Codeine
  • Aspirin, ASA; Citric Acid; Sodium Bicarbonate
  • Aspirin, ASA; Dipyridamole
  • Aspirin, ASA; Omeprazole
  • Aspirin, ASA; Oxycodone
  • Aspirin, ASA; Pravastatin
  • Belladonna Alkaloids; Ergotamine; Phenobarbital
  • Belladonna; Opium
  • Benzhydrocodone; Acetaminophen
  • Betrixaban
  • Bexarotene
  • Bivalirudin
  • Brompheniramine; Guaifenesin; Hydrocodone
  • Brompheniramine; Hydrocodone; Pseudoephedrine
  • Bupropion
  • Bupropion; Naltrexone
  • Cangrelor
  • Cannabidiol
  • Carbinoxamine; Hydrocodone; Phenylephrine
  • Carbinoxamine; Hydrocodone; Pseudoephedrine
  • Chlorambucil
  • Chloramphenicol
  • Chlorpheniramine; Codeine
  • Chlorpheniramine; Dihydrocodeine; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
  • Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Hydrocodone
  • Chlorpheniramine; Hydrocodone; Phenylephrine
  • Chlorpheniramine; Hydrocodone; Pseudoephedrine
  • Cilostazol
  • Cimetidine
  • Citalopram
  • Cladribine
  • Clofarabine
  • Codeine
  • Codeine; Guaifenesin
  • Codeine; Phenylephrine; Promethazine
  • Codeine; Promethazine
  • Collagenase
  • Cyclophosphamide
  • Dabigatran
  • Dabrafenib
  • Dalteparin
  • Danaparoid
  • Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
  • Dasatinib
  • Defibrotide
  • Denileukin Diftitox
  • Desirudin
  • Desvenlafaxine
  • Dihydrocodeine; Guaifenesin; Pseudoephedrine
  • Diphenhydramine; Hydrocodone; Phenylephrine
  • Dipyridamole
  • Doxercalciferol
  • Drotrecogin Alfa
  • Duloxetine
  • Edoxaban
  • Enoxaparin
  • Enzalutamide
  • Eptifibatide
  • Escitalopram
  • Eslicarbazepine
  • Esomeprazole
  • Esomeprazole; Naproxen
  • Estramustine
  • Etravirine
  • Fedratinib
  • Felbamate
  • Fenofibric Acid
  • Fentanyl
  • Fish Oil, Omega-3 Fatty Acids (Dietary Supplements)
  • Fluconazole
  • Fludarabine
  • Fluoxetine
  • Fluoxetine; Olanzapine
  • Fluvoxamine
  • Folate analogs
  • Fondaparinux
  • Garlic, Allium sativum
  • Ginger, Zingiber officinale
  • Ginkgo, Ginkgo biloba
  • Glimepiride; Pioglitazone
  • Glimepiride; Rosiglitazone
  • Green Tea
  • Guaifenesin; Hydrocodone
  • Guaifenesin; Hydrocodone; Pseudoephedrine
  • Heparin
  • Homatropine; Hydrocodone
  • Hydrochlorothiazide, HCTZ; Telmisartan
  • Hydrocodone
  • Hydrocodone; Ibuprofen
  • Hydrocodone; Phenylephrine
  • Hydrocodone; Potassium Guaiacolsulfonate
  • Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
  • Hydrocodone; Pseudoephedrine
  • Hydromorphone
  • Ibritumomab Tiuxetan
  • Ibrutinib
  • Ibuprofen; Oxycodone
  • Icosapent ethyl
  • Iloprost
  • Inotersen
  • Intravenous Lipid Emulsions
  • Isoniazid, INH
  • Isoniazid, INH; Pyrazinamide, PZA; Rifampin
  • Isoniazid, INH; Rifampin
  • Ketoconazole
  • Lepirudin
  • Levomethadyl
  • Levomilnacipran
  • Levorphanol
  • Lomustine, CCNU
  • Loperamide
  • Loperamide; Simethicone
  • Luliconazole
  • Meperidine
  • Meperidine; Promethazine
  • Mercaptopurine, 6-MP
  • Metformin; Pioglitazone
  • Metformin; Repaglinide
  • Metformin; Rosiglitazone
  • Methadone
  • Methoxsalen
  • Methylsulfonylmethane, MSM
  • Milnacipran
  • Modafinil
  • Morphine
  • Morphine; Naltrexone
  • Mycophenolate
  • Nelarabine
  • Nicardipine
  • Nonsteroidal antiinflammatory drugs
  • Obinutuzumab
  • Omeprazole
  • Omeprazole; Amoxicillin; Rifabutin
  • Omeprazole; Sodium Bicarbonate
  • Oritavancin
  • Oxcarbazepine
  • Oxycodone
  • Oxymorphone
  • Paroxetine
  • Pegaspargase
  • Pentosan
  • Pentostatin
  • Pentoxifylline
  • Perindopril; Amlodipine
  • Photosensitizing agents (topical)
  • Pioglitazone
  • Platelet Glycoprotein IIb/IIIa Inhibitors
  • Prasterone, Dehydroepiandrosterone, DHEA (Dietary Supplements)
  • Prasterone, Dehydroepiandrosterone, DHEA (FDA-approved)
  • Prasugrel
  • Propoxyphene
  • Purine analogs
  • Remifentanil
  • Repaglinide
  • Rivaroxaban
  • Rosiglitazone
  • Rucaparib
  • Selexipag
  • Sertraline
  • Sodium Hyaluronate, Hyaluronic Acid
  • Sufentanil
  • Sulfinpyrazone
  • Tapentadol
  • Telmisartan
  • Thioguanine, 6-TG
  • Thrombolytic Agents
  • Ticagrelor
  • Ticlopidine
  • Tirofiban
  • Tramadol
  • Trazodone
  • Treprostinil
  • Tretinoin, ATRA
  • Venlafaxine
  • Verteporfin
  • Vilazodone
  • Vorapaxar
  • Voriconazole
  • Vorinostat
  • Vortioxetine
  • Warfarin

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