Clopidogrel

Clopidogrel

[1 tablet 99 cents]

ADMINISTRATION ROUTES:

  • PO, NG

ALTERNATIVE NAMES:

  • Plavix

ICU INDICATIONS:

  1. treatment of acute coronary syndromes (especially post angioplasty when stents are deployed)
  2. prophylaxis of vascular ischaemic events (mainly inpatients with coronarystents)

PRESENTATION AND ADMINISTRATION:

  • PO:
    Apo-clopidogrel 75mg tablets (reddish brown) Plavix 75mg tablets (pink)

DOSAGE:

  • PO /NG:
    300mg loading dose followed by 75mg daily
    Plavix brand clopidogrel can be crushed, mixed with water and administered via a nasogastric tube.

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

  • Dose as in normal renal function

DOSAGE IN PAEDIATRICS:

  • PO:
    1.5mg/kg daily
    See PRECAUTIONS Paediatric Use

CLINICAL PHARMACOLOGY:

  • Clopidogrel is a platelet aggregation inhibitor. It selectively inhibits the binding of adenosine diphosphate (ADP) to its platelet receptor and the subsequent ADP-mediated activation of the glycoprotein GPIIb/IIIa complex, thereby inhibiting platelet aggregation.

CONTRAINDICATIONS:

  1. hypersensitivity to clopidogrel
  2. active bleeding

WARNINGS

  • Thrombotic Thrombocytopenic Purpura (TTP)
    TTP has been reported rarely following use of clopidogrel bisulfate, sometimes after a short exposure (<2 weeks). TTP is a serious condition that can be fatal and requires urgent treatment including plasmapheresis (plasma exchange). It is characterized by thrombocytopenia, microangiopathic hemolytic anemia (schistocytes [fragmented RBCs] seen on peripheral smear), neurological findings, renal dysfunction, and fever

PRECAUTIONS

  • General:
    Clopidogrel bisulfate prolongs the bleeding time and therefore should be used with caution in patients who may be at risk of increased bleeding from trauma, surgery, or other pathological conditions (particularly gastrointestinal and intraocular). If a patient is to undergo elective surgery and an antiplatelet effect is not desired, clopidogrel bisulfate should be discontinued 5 days prior to surgery.
    In patients with recent TIA or stroke who are at high risk for recurrent ischemic events, the combination of aspirin and clopidogrel has not been shown to be more effective than clopidogrel alone, but the combination has been shown to increase major bleeding. In CAPRIE, clopidogrel bisulfate was associated with a rate of gastrointestinal bleeding of 2.0% vs 2.7% on aspirin. In CURE, the incidence of major gastrointestinal bleeding was 1.3% vs 0.7% (clopidogrel bisulfate + aspirin versus placebo + aspirin, respectively). Clopidogrel bisulfate should be used with caution in patients who have lesions with a propensity to bleed (such as ulcers).
  • Laboratory Tests:
    No tests in addition to routine ICU tests are indicated
  • Drug/Laboratory Test Interactions:
    None noted

IMPORTANT DRUG INTERACTIONS FOR THE ICU

  • The risk of bleeding increases when clopidogrel is combined with other anticoagulants. Omeprazole and other PPIs decrease the antiplatelet effect of clopidogrel. It may be more appropriate to use Ranitidine as ulcer prophylaxis in patients on clopidogrel. If clopidogrel is used concomitantly with a PPI the dosages should be separated by 12 hours.

ADVERSE REACTIONS

  • Body as a Whole:
    Bleeding, anaphylaxis, angioedema, serum sickness, fatigue
  • Haematological:
    TTP, leucopenia, eosinophilia
  • Gastrointestinal System:
    Pancreatitis, stomatitis, colitis
  • Respiratory System:
    Interstitial pneumonitis, bronchospasm
  • Skin:
    Rash

Critical Care Drug Manual

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