Cochin Cardiac Club

Health Blog by Dr.Uday Nair


What Is Clopidogrel?

Clopidogrel bisulfate is a medication that is used to prevent harmful blood clots from forming in people who have had a recent heart attack, stroke, or severe chest pain requiring hospitalization.
It is used under the trade name-Plavix,Deplat,Plagerine,e.t.c.

What Is Clopidogrel Used For?

As mentioned, clopidogrel is licensed to prevent blood clots from forming after a heart attack, stroke, or chest pain that requires hospitalization. Also, the medication may be used to prevent clots in people with poor circulation, such as those who have peripheral artery disease (PAD). Preventing blood clots from forming and blocking blood vessels helps reduce the risk of having another related heart attack or stroke.

How Does It Work?

Clopidogrel affects platelets (a type of blood cell), which clump together to form clots and stop bleeding in the event of a cut or injury.

 It is part of a class of drugs called antiplatelet medications (or blood thinners). Antiplatelet medications help prevent platelets from sticking together and forming a potentially harmful clot. This helps your blood flow more easily. Clots that form in blood vessels can block the blood flow to important organs, such as the heart or brain, and may lead to heart attacks and strokes. As a result, clopidogrel reduces the risk of having a future event, while also improving blood circulation in people with peripheral vascular disease.

When and How Do I Take It?

Clopidogrel comes in tablet form. It should be taken by mouth once a day. You can take this medication with or without food.Normally this tablet should not taken on an empty stomach.
For clopidogrel to work properly, you have to take it as prescribed. The medication will not work if you stop taking it.

Dosing Information

The dose of clopidogrel your doctor recommends will vary, depending on a number of factors, including:
  • The medical condition being treated
  • Other medical conditions you may have
  • Other medications you may be taking.
As is always the case, do not adjust your dose unless your doctor specifically tells you to do so.

Side Effects of Clopidogrel

As with any medicine, side effects are possible with clopidogrel. However, not everyone who takes the drug will experience side effects. If people do develop side effects, they are usually minor, meaning they require no treatment or are easily treated by you or your healthcare provider.
Common side effects include but are not limited to:
  • Major bleeding
  • Headache
  • Dizziness
  • Pain, including back pain and abdominal (stomach) pain
  • Diarrhea
  • Upset stomach or indigestion (dyspepsia)
  • Bruising
  • Bloody nose
  • Unexplained rash
  • Itchy skin.
Because clopidogrel can increase the risk for major or life-threatening bleeding, contact your doctor immediately if you notice that it takes longer for bleeding to stop, you have any unusual bleeding, or have any of the following symptoms:
  • Bloody nose
  • Black, tarry stools
  • Blood in the urine or stools
  • Vomiting blood
  • Red or purple spots on the skin
  • Itchy skin or rash. 

    Other Side Effects of Clopidogrel

    There are other possible clopidogrel side effects that can occur. These side effects occurred in less than 2 percent of patients taking clopidogrel. For these side effects, it is difficult to tell whether the side effect is because of clopidogrel or something else.
    Some of these possible side effects of clopidogrel include, but are not limited to:
    • Decreases in certain cells involved with the immune system
    • Serious skin or allergic reactions
    • Decreases in platelets
    • Stomach bleeding or ulcers
    • Constipation
    • Urinary tract infection (UTI)
    • Fatigue
    • High blood pressure (hypertension)
    • Joint pain
    • Depression
    • Anemia
    • Difficulty breathing
    • Thrombotic thrombocytopenic purpura 

    Side Effects of Clopidogrel: Summary

    It is possible that you may experience some or none of these side effects of clopidogrel. Unfortunately, there is no way for your doctor to know beforehand if you will have side effects from a medicine that you have never tried. Therefore, make sure to let your doctor know if you develop any side effects. Also, let your doctor know if you develop something that "just does not seem right." While it may not be a side effect of clopidogrel, your doctor will be able to diagnose and treat the problem.

    Drug Interactions With Clopidogrel

    Drug interactions with clopidogrel may involve medications such as warfarin, nonsteroidal anti-inflammatory drugs (NSAIDs), and phenytoin. For example, taking clopidogrel and warfarin together may cause the body to metabolize both medications differently than intended, and taking nonsteroidal anti-inflammatory drugs (NSAIDs) with clopidogrel can increase the risk of bleeding. Herbal and nutritional supplements can also interact with clopidogrel and possibly increase the risk of bleeding.(s has a number of medicines that it can potentially interact with. Some of these drug interactions with clopidogrel involve medications such as:

    • CYP 2C19 inhibitor medications, including:
      • Armodafinil (Nuvigil®)
      • Bortezomib (Velcade®)
      • Cimetidine (Tagamet®)
      • Delavirdine (Rescriptor®)
      • Efavirenz (Sustiva®) or efavirenz, emtricitabine, and tenofovir (Atripla®)
      • Esomeprazole (Nexium®)
      • Etravirine (Intelence™)
      • Felbamate (Felbatol®)
      • Fluconazole (Diflucan®)
      • Fluoxetine (Prozac®, Sarafem®, Selfemra™)
      • Fluvoxamine (Luvox®, Luvox® CR)
      • Gemfibrozil (Lopid®)
      • Isoniazid
      • Ketoconazole (Nizoral®)
      • Lansoprazole (Prevacid®, Prevacid® 24HR) 
      • Miconazole
      • Modafinil (Provigil®)
      • Nicardipine (Cardene®)
      • Omeprazole (Prilosec®, Prilosec OTC®)
      • Omeprazole/sodium bicarbonate (Zegerid®, Zegerid OTC™) 
      • Rabeprazole (Aciphex®)
      • Sertraline (Zoloft®)
      • Ticlopidine (Ticlid®)
      • Tranylcypromine (Parnate®)
    • Fluvastatin (Lescol®)  
    • Medications that "thin" the blood (such as anticoagulant and antiplatelet drugs) or otherwise increase bleeding risk, such as:
      • Antithrombin (ATryn®, Thrombate III®)
      • Argatroban
      • Aspirin (Bayer® and others)
      • Bivalirudin (Angiomax®)
      • Cilostazol (Pletal®)
      • Dabigatran (Pradaxa®)
      • Dipyridamole (Persantine®)
      • Drotrecogin alfa (Xigris®)
      • Eptifibatide (Integrilin®)
      • Fondaparinux (Arixtra®)
      • Heparin or heparin-like products, including dalteparin (Fragmin®), enoxaparin (Lovenox®), or tinzaparin (Innohep®)
      • Lepirudin (Refludan®)
      • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as:
        • Celecoxib (Celebrex®)
        • Diclofenac (Cambia™, Cataflam®, Flector®, Pennsaid®, Solaraze® Gel, Voltaren®, Voltaren® Gel, Voltaren®-XR, Voltaren Ophthalmic®, Zipsor™)
        • Etodolac (Lodine®, Lodine® XL)
        • Ibuprofen (Motrin®, Advil®, Nuprin®)
        • Indomethacin (Indocin®, Indocin SR®)
        • Ketoprofen (Orudis®, Actron®, Oruvail®)
        • Ketorolac (Sprix™, Toradol®)
        • Meloxicam (Mobic®)
        • Nabumetone (Relafen®)
        • Naproxen (Naprosyn®) or naproxen sodium (Aleve®, Anaprox®, Naprelan®)
        • Oxaprozin (Daypro®)
        • Piroxicam (Feldene®)
      • Pentoxifylline (Trental®)
      • Prasugrel (Effient®)
      • Thrombolytics, such as:
        • Alteplase (Activase®)
        • Reteplase (Retavase®)
        • Streptokinase (Streptase®)
        • Tenecteplase (TNKase®)
      • Ticlopidine (Ticlid®)
      • Tirofiban (Aggrastat®)
      • Warfarin (Coumadin®, Jantoven®)
    • Phenytoin (Dilantin®, Phenytek®)
    • Tamoxifen (Nolvadex®)
    • Tolbutamide (Orinase®)
    • Torsemide (Demadex®).

    Several herbal and nutritional supplements can also interact with clopidogrel and may increase the risk of bleeding. Examples of these include, but are not limited to:
    • Dong quai
    • Feverfew
    • Garlic
    • Ginger
    • Ginkgo biloba
    • Ginseng
    • St. John's wort
    • Fish oil supplements. 

Final Thoughts

It is possible that not all drug interactions with clopidogrel were discussed in this article. Therefore, you should talk with your pharmacist or doctor about drug or herbal interactions with clopidogrel that may apply to you.

Precautions and Warnings for Clopidogrel: What Should I Tell My doctor?

You should talk with your doctor prior to taking

 clopidogrel bisulfate (Plavix,Plagerine,Deplat) if you have:
  • Active bleeding anywhere in your body, such as a stomach ulcer or bleeding within the head (type of stroke)
  • A bleeding or blood disorder
  • Liver disease
  • Kidney disease
  • Any allergies
  • Had any recent injuries or surgeries.
Also, let your doctor know if you:
  • Are going to have any type of surgery or other invasive procedures
  • Are pregnant or breastfeeding.
If after starting clopidogrel, you feel that it takes longer than normal for you to stop bleeding, even after a minor cut, you should contact your doctor.
Also, inform your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements.

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