clopidogrel bisulfate

clopidogrel bisulfate

Plavix

Pharmacologic class: Platelet aggregation inhibitor

Therapeutic class: Antiplatelet drug

Pregnancy risk category B

Action

Inhibits platelet aggregation by blocking binding of adenosine diphosphate to platelets, thereby preventing thrombus formation

Availability

Tablets: 75 mg

⊘Indications and dosages

➣ To reduce atherosclerotic events in patients with recent myocardial infarction (MI) or cerebrovascular accident and in those with established peripheral arterial disease or acute coronary syndrome

Adults: 75 mg/day P.O.

➣ Acute coronary syndrome (unstable angina or non-Q-wave MI)

Adults: 300 mg P.O. as a loading dose, then 75 mg/day P.O.

Contraindications

• Hypersensitivity to drug
• Active pathologic bleeding

Precautions

Use cautiously in:
• severe hepatic impairment, GI bleeding, ulcer disease
• increased risk of bleeding
• pregnant or breastfeeding patients
• children.

Administration

• Give with or without food.
• Know that drug may need to be discontinued 5 days before surgery.

Route	Onset	Peak	Duration
P.O.	Variable	60 min	3-4 hr

Adverse reactions

CNS: depression, dizziness, fatigue, headache

CV: chest pain, hypertension

EENT: epistaxis, rhinitis

GI: diarrhea, abdominal pain, dyspepsia, gastritis, GI bleeding

Hematologic: bleeding, neutropenia, thrombotic thrombocytopenic purpura

Metabolic: hypercholesterolemia, gout

Musculoskeletal: joint pain, back pain

Respiratory: cough, dyspnea, bronchitis, upper respiratory tract infection, bronchospasm

Skin: pruritus, rash, angioedema

Other: hypersensitivity reactions, anaphylactic reactions

Interactions

Drug-drug. Abciximab, aspirin, eptifibatide, heparin, heparinoids, nonsteroidal anti-inflammatory drugs (NSAIDs), thrombolytics, ticlopidine, tirofiban, warfarin: increased risk of bleeding

Fluvastatin, many NSAIDs, phenytoin, tamoxifen, tolbutamide, torsemide: interference with metabolism of these drugs

Drug-diagnostic tests. Bilirubin, hepatic enzymes, nonprotein nitrogen, total cholesterol, uric acid: increased levels

Platelets: decreased count

Drug-herbs. Anise, arnica, chamomile, clove, fenugreek, feverfew, garlic, ginger, ginkgo, ginseng: increased risk of bleeding

Patient monitoring

• Monitor hemoglobin and hematocrit periodically.
• Monitor patient for unusual bleeding or bruising; drug significantly increases risk of bleeding.
• Assess for occult GI blood loss if patient is receiving naproxen concurrently with clopidogrel.

Patient teaching

☞ Advise patient to immediately report unusual or acute chest pain, respiratory difficulty, rash, unresolved bleeding, diarrhea, GI distress, nosebleed, or acute headache.
• Instruct patient to tell all health care providers that he's taking clopidogrel, especially if surgery is scheduled or new drugs are prescribed.
• Tell patient drug may cause headache and dizziness. Caution him to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• Advise patient to minimize adverse GI effects by eating small, frequent meals or chewing gum.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and herbs mentioned above.