CLOPIDOGREL BISULFATE

(clo-pi'do-grel)

Plavix
Classifications: anticoagulants; antiplatelet agent;
Therapeutic: anticoagulants; antiplatelet agent
Pregnancy Category: B

Availability

75 mg tablets

Action

Inhibits platelet aggregation by selectively preventing the binding of adenosine diphosphate to its platelet receptor. It is an analog of ticlopidine. The drug's effect on the adenosine diphosphate receptor of a platelet is irreversible.

Therapeutic Effect

Clopidogrel prolongs bleeding time, thereby reducing atherosclerotic events in high-risk patients.

Uses

Acute coronary syndrome (ST or non-ST elevations). Secondary prevention of MI, stroke, and vascular death in patients with recent MI, stroke, unstable angina or established peripheral arterial disease.

Unlabeled Uses

Reduction of restenosis after stent placement.

Contraindications

Hypersensitivity to clopidogrel; intracranial hemorrhage, peptic ulcer, or any other active pathologic bleeding. Discontinue clopidogrel 7 d before surgery and during lactation. Safety and efficacy not established in children.

Cautious Use

Concurrent use with drugs that might induce gastrointestinal bleeding; GI bleeding, peptic ulcer disease; hepatic impairment (moderate to severe); severe renal impairment; patients at risk for increased bleeding; pregnancy (category B).

Route & Dosage

Secondary Prevention
Adult: PO 75 mg q.d.

Acute Coronary Syndrome (Non-ST Elevation)
Adult: PO 300 mg loading dose then 75 mg q.d. (use with aspirin)

Administration

Oral

Do not administer to persons with active pathologic bleeding.
Discontinue drug 7 d prior to surgery.
Store at 15°–30° C (59°–86° F) in tightly closed container and protect from light.

Adverse Effects (≥1%)

Body as a Whole: Flu-like syndrome, fatigue, pain, arthralgia, back pain. CV: Chest pain, edema, hypertension, thrombocytopenic purpura. GI: Abdominal pain, dyspepsia, diarrhea, nausea, hypercholesterolemia. Hematologic: Thrombotic thrombocytopenic purpura, epistaxis. CNS: Headache, dizziness, depression. Respiratory: URI, dyspnea, rhinitis, bronchitis, cough. Skin: Rash, pruritus.

Interactions

Drug: nsaids may increase risk of bleeding events. Herbal: Garlic, ginger, ginkgo may increase risk of bleeding.

Pharmacokinetics

Absorption: Rapidly absorbed from GI tract. Onset: 2 h; reaches steady state in 3–7 d. Distribution: 94–98% protein bound. Metabolism: Rapidly hydrolyzed in plasma to active metabolite. Elimination: 50% in urine and 50% in feces. Half-Life: 8 h.

Nursing Implications

Assessment & Drug Effects

Carefully monitor for and immediately report S&S of GI bleeding, especially when coadministered with NSAIDs, aspirin, heparin, or warfarin.
Lab tests: Periodic platelet count and lipid profile.
Evaluate patients with unexplained fever or infection for myelotoxicity.

Patient & Family Education

Report promptly any unusual bleeding (e.g., black, tarry stools).
Avoid chronic aspirin or NSAID use unless approved by physician.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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