Generic Name: clopidogrel (kloe PID oh grel)
Brand Names: Plavix
What is clopidogrel?
Clopidogrel keeps the platelets in your blood from coagulating (clotting) to prevent unwanted blood clots that can occur with certain heart or blood vessel conditions.
Clopidogrel is used to prevent blood clots after a recent heart attack or stroke, and in people with certain disorders of the heart or blood vessels.
Clopidogrel may also be used for other purposes not listed in this medication guide.
What is the most important information I should know about clopidogrel?
Clopidogrel keeps your blood from coagulating (clotting) to prevent unwanted blood clots that can occur with certain heart or blood vessel conditions. Because of this drug action, clopidogrel can make it easier for you to bleed, even from a minor injury. Contact your doctor or seek emergency medical attention if you have bleeding that will not stop.
You may also have bleeding on the inside of your body, such as in your stomach or intestines. Call your doctor at once if you have black or bloody stools, or if you cough up blood or vomit that looks like coffee grounds. These could be signs of bleeding in your digestive tract. Avoid drinking alcohol. It may increase your risk of bleeding in your stomach or intestines. If you need surgery or dental work, tell the surgeon or dentist ahead of time that you are using clopidogrel. You may need to stop using the medicine for at least 5 days before having surgery, to prevent excessive bleeding. Follow your doctor's instructions and start taking clopidogrel again as soon as possible. While you are taking clopidogrel, do not take aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs) without your doctor's advice. NSAIDs include ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn, Naprelan, Treximet), celecoxib (Celebrex), diclofenac (Cataflam, Voltaren), indomethacin (Indocin), meloxicam (Mobic), and others.
Tell your doctor about all other medicines you use to prevent blood clots.
What should I discuss with my healthcare provider before taking clopidogrel?
Do not use this medication if you are allergic to clopidogrel, or if you have any active bleeding such as a stomach ulcer or bleeding in the brain (such as from a head injury).
If you have any of these other conditions, you may need a dose adjustment or special tests:
a bleeding or blood clotting disorder, such as TTP (thrombocytopenic purpura) or hemophilia;
a history of stroke, including TIA ("mini-stroke");
a stomach ulcer or ulcerative colitis; or
kidney disease.
FDA pregnancy category B. This medication is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether clopidogrel passes into breast milk or if it could harm a nursing baby. You should not breast-feed while you are taking clopidogrel.
How should I take clopidogrel?
Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.
Take this medication with a full glass of water.
Clopidogrel can be taken with or without food.
Because clopidogrel keeps your blood from coagulating (clotting) to prevent unwanted blood clots, it can also make it easier for you to bleed, even from a minor injury. Contact your doctor or seek emergency medical attention if you have bleeding that will not stop.
If you need surgery or dental work, tell the surgeon or dentist ahead of time that you are using clopidogrel. You may need to stop using the medicine for at least 5 days before having surgery, to prevent excessive bleeding. Follow your doctor's instructions and start taking clopidogrel again as soon as possible. Do not stop using clopidogrel without first talking to your doctor. Use clopidogrel regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.
To be sure this medicine is not causing harmful effects, your blood will need to be tested often. Visit your doctor regularly.
Store at room temperature away from moisture and heat.
See also: Clopidogrel dosage (in more detail)
What happens if I miss a dose?
Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
Overdose symptoms may include vomiting, feeling exhausted or short of breath, and blood in your stools or vomit.
What should I avoid while taking clopidogrel?
While you are taking clopidogrel, do not take aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs) without your doctor's advice. NSAIDs include ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn, Naprelan, Treximet), celecoxib (Celebrex), diclofenac (Cataflam, Voltaren), indomethacin (Indocin), meloxicam (Mobic), and others.
Avoid activities that may increase your risk of bleeding or injury. Use extra care to prevent bleeding while shaving or brushing your teeth.
Avoid drinking alcohol. It may increase your risk of bleeding in your stomach or intestines.
Clopidogrel side effects
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using clopidogrel and call your doctor at once if you have any of these serious side effects:
nosebleed or other bleeding that will not stop;
bloody or tarry stools, blood in your urine;
coughing up blood or vomit that looks like coffee grounds;
chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling;
sudden numbness or weakness, especially on one side of the body;
sudden headache, confusion, problems with vision, speech, or balance;
pale skin, weakness, fever, or jaundice (yellowing of the skin or eyes); or
easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), purple or red pinpoint spots under your skin.
Less serious side effects may include itching.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Clopidogrel Dosing Information
Usual Adult Dose for Ischemic Stroke:
75 mg orally once a day with or without food.
Aspirin therapy should be initiated and continued in combination with clopidogrel.
Usual Adult Dose for Myocardial Infarction:
75 mg orally once a day with or without food.
Aspirin therapy should be initiated and continued in combination with clopidogrel.
Usual Adult Dose for Acute Coronary Syndrome -- Prophylaxis:
75 mg orally once a day with or without food.
Aspirin therapy should be initiated and continued in combination with clopidogrel.
Usual Adult Dose for Peripheral Arterial Disease:
75 mg orally once a day with or without food.
Aspirin therapy should be initiated and continued in combination with clopidogrel.
Usual Adult Dose for Acute Coronary Syndrome:
Unstable angina, non ST segment elevation myocardial infarction (UA/NSTEMI): Initial: 300 mg loading dose, followed by 75 mg once daily for at least 1 month and ideally up to 12 months (in combination with aspirin 75 to 162 mg once daily indefinitely).
ST segment elevation acute myocardial infarction (STEMI): 75 mg once daily (in combination with aspirin 162 to 325 mg initially, followed by 81 to 162 mg/day); Note: The CLARITY TIMI 28 study used a 300 mg loading dose of clopidogrel (with thrombolysis) demonstrating an improvement in the patency rate of the infarct related artery and reduction in ischemic complications. The duration of therapy was less than 28 days (usually until hospital discharge) unless non primary percutaneous coronary intervention (PCI) was performed.
Usual Adult Dose for Percutaneous Coronary Intervention:
Percutaneous coronary intervention (PCI) for UA/NSTEMI or STEMI:
Loading dose: 300 to 600 mg (600 mg may be preferred for early invasive strategy with UA/NSTEMI) given as early as possible before or at the time of PCI followed by 75 mg once daily. Note: If an initial loading dose of 300 mg was given prior to PCI, a supplemental loading dose of 300 mg (total loading dose: 600 mg) may be administered. For patients with UA/NSTEMI, it has been recommended that the loading dose be given at least 2 hours (or 24 hours in patients unable to take aspirin) prior to PCI.
Higher vs standard maintenance dosing: May consider a maintenance dose of 150 mg once daily for 6 days, then 75 mg once daily thereafter in patients not at high risk for bleeding; however, in another study, in patients with high on treatment platelet reactivity, the use of 150 mg once daily for 6 months did not demonstrate a difference in 6 month incidence of death from cardiovascular causes, nonfatal MI, or stent thrombosis compared to standard dose therapy (Price, 2011).
Duration of clopidogrel (in combination with aspirin) after stent placement: Premature interruption of therapy may result in stent thrombosis with subsequent fatal and nonfatal MI. With STEMI, clopidogrel for at least 12 months regardless of stent type (either bare metal or drug eluting stent) is recommended. With UA/NSTEMI, at least 12 months of clopidogrel is recommended in patients receiving a drug eluting stent (DES) unless the risk of bleeding outweighs the benefits. For bare metal stent (BMS) placement, at least 1 month and ideally up to 12 months duration is recommended unless the risk of bleeding outweighs the benefits; then, a minimum of 2 weeks is recommended. In either setting, a duration greater than 15 months may be considered in patients with DES placement. For patients without ongoing ACS, clopidogrel should be continued for at least 1 month (for BMS) or at least 12 months (for DES).
Usual Geriatric Dose for Acute Coronary Syndrome:
The American College of Chest Physicians recommends:
Patients over 75 years: 75 mg once daily for up to 28 days (with or without thrombolysis)
Usual Pediatric Dose for Platelet Aggregation Inhibition:
Note: Safety and efficacy have not been established in pediatric patients; optimal dose is not known; limited dosing information is available; further pediatric studies are needed.
Neonates and Infants up to 2 years: 0.2 mg/kg once daily was found to achieve a mean inhibition of platelet aggregation similar to adults receiving the recommended dose. This dose comes from the PICOLO study which included pediatric patients with a systemic to pulmonary artery shunt, intracardiac or intravascular stent, Kawasaki disease, or arterial graft; 79% of patients received concomitant aspirin; patients less than 2 kg and those born at less than 35 weeks gestational age were excluded.
Children over 2 years of age: Optimal dose is not established; some centers use the following: Initial dose: 1 mg/kg once daily; titrate to response; in general, do not exceed adult dose.
What other drugs will affect clopidogrel?
Tell your doctor about all other medicines you use to prevent blood clots, including:
abciximab (ReoPro);
dalteparin (Fragmin);
enoxaparin (Lovenox);
eptifibatide (Integrilin);
fondaparinux (Arixtra);
heparin;
ticlopidine (Ticlid);
tinzaparin (Innohep);
tirofiban (Aggrastat);
urokinase (Abbokinase); and
warfarin (Coumadin, Jantoven).
Tell your doctor about all other medicines you use, especially:
armodafanil (NuVigil) or modafanil (Provigil);
fluoxetine (Prozac) or fluvoxamine (Luvox);
gemfibrozil (Lopid);
isoniazid (Rifamate, Rifater);
a cancer medication such as dasatinib (Sprycel), letrozole (Femara), ibritumomab (Zevalin), or tositumomab (Bexxar);
certain stomach acid reducers, such as cimetidine (Tagamet), esomeprazole (Nexium), or omeprazole (Prilosec, Prilosec OTC, Zegerid);
an antifungal medication such as fluconazole (Diflucan), ketoconazole (Nizoral), or voriconazole (Vfend);
HIV medications such as delavirdine (Rescriptor), efavirenz (Sustiva, Atripla), etravirine (Intelence), or tipranavir (Aptivus); or
seizure medication such as felbamate (Felbatol) or oxcarbazepine (Trileptal).
This list is not complete and other drugs may interact with clopidogrel. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.
More clopidogrel resources
- Clopidogrel Side Effects (in more detail)
- Clopidogrel Dosage
- Clopidogrel Use in Pregnancy & Breastfeeding
- Drug Images
- Clopidogrel Drug Interactions
- Clopidogrel Support Group
- 26 Reviews for Clopidogrel - Add your own review/rating
- clopidogrel Advanced Consumer (Micromedex) - Includes Dosage Information
- Clopidogrel Prescribing Information (FDA)
- Clopidogrel MedFacts Consumer Leaflet (Wolters Kluwer)
- Clopidogrel Professional Patient Advice (Wolters Kluwer)
- Clopidogrel Bisulfate Monograph (AHFS DI)
- Plavix Prescribing Information (FDA)
- Plavix Consumer Overview
Compare clopidogrel with other medications
- Acute Coronary Syndrome
- Acute Coronary Syndrome, Prophylaxis
- Heart Attack
- Ischemic Stroke
- Ischemic Stroke, Prophylaxis
- Percutaneous Coronary Intervention
- Peripheral Arterial Disease
- Platelet Aggregation Inhibition
- Transient Ischemic Attack
Where can I get more information?
- Your pharmacist can provide more information about clopidogrel.
See also: clopidogrel side effects (in more detail)
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