Clopidogrel

Indications

Clopidogrel is used for: Coronary Artery Disease, Acute coronary syndrome, Myocardial infarction, Peripheral vascular disease, Cerebrovascular disease, Atherosclerosis, Thromboembolic disorders, Unstable angina, Stroke

Adult Dose

Oral Prophylaxis of thromboembolic disorders, Recent MI, Stroke, or Established Peripheral Arterial Disease, Coronary Artery Disease Adult: 75 mg once daily. Acute coronary syndrome Adult: For ST-elevation MI: In combination w/ aspirin: 75 mg once daily. <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 qDay with or without thrombolytics >75 years No loading dose 75 mg for 14 days up to 12 months (if no bleeding) For unstable angina, non-ST-elevation MI: In combination w/ aspirin: Initially, 300 mg loading dose, followed by 75 mg once daily for up to 12 mth. Hepatic impairment: Use caution; experience limited

Child Dose

Renal Dose

Renal impairment: Dose adjustment not necessary

Administration

May be taken with or without food.

Contra Indications

Hypersensitivity. Active pathological bleeding. admin within 7 days after MI and ischaemic stroke, coagulation disorders. Lactation.

Precautions

Patients at risk of increased bleeding from trauma, surgery, or other pathological conditions; ulcer; renal and hepatic impairment; history of bleeding or haemostatic disorders. Pregnancy. Lactation: Not known whether drug is excreted in breast milk; not recommended

Pregnancy-Lactation

Interactions

Co-admin with NSAIDs may increase the risk of stomach and intestinal bleeding. High-dose clopidogrel may lead to increased warfarin levels thus increasing the risk of bleeding. High-dose clopidogrel may also inhibit P450 (2C9), thus interfering with the metabolism of phenytoin, tamoxifen, torasemide, fluvastatin and some NSAIDs. Avoid c

Adverse Effects

Side effects of Clopidogrel : 1-10% Upper respiratory tract infection (8.7%),Chest pain (8.3%),Headache (7.6%),Flulike syndrome (7.5%),Arthralgia (6%),Pain (6%),Dizziness (6%),Diarrhea (4.5%),Rash (4.2%),Rhinitis (4.2%),Depression (3.6%),Urinary tract infection (3.1%) <1% Severe neutropenia,Thrombotic thrombocytopenic purpura,Acute liver failure,Aplastic anemia,Hypotension,Hepatitis,Myalgia,Eczema,Erythema,Agranulocytosis Potentially Fatal: Bleeding disorders including GI and intracranial haemorrhage. Blood dyscrasias.

Mechanism of Action

Clopidogrel inhibits adenosine diphosphate (ADP) from binding to its receptor sites on the platelets and subsequent activation of glycoprotein GP IIb/IIIa complex thus preventing fibrinogen binding, platelet adhesion and aggregation.