Clopidogrel

💊 What is Clopidogrel used for?

• •The label says clopidogrel is used to reduce the rate of heart attack and stroke in adults with acute coronary syndrome (unstable angina, non-ST-elevation heart attack, or ST-elevation heart attack that is managed with medicine). It is given with aspirin for these conditions. It is also used to reduce heart attack and stroke in people with established peripheral arterial disease (poor circulation in the legs), a recent heart attack, or a recent stroke. The label says it is not known whether the medicine is safe and effective in children.

How it works

Platelets are blood cells that help blood clot. Clopidogrel helps prevent platelets from sticking together and forming a clot that can block an artery. The label explains that the medicine must be changed by the body (through the CYP2C19 enzyme system) into an active form to work.

How it is usually taken

• •The label says clopidogrel is taken by mouth and is usually taken once a day. Take it exactly as your doctor tells you, and do not change the dose or stop without talking to your doctor first. Some people are given a larger starting dose, called a loading dose, followed by a smaller daily dose. When used for acute coronary syndrome, the label says it is taken with aspirin as your doctor instructs. The label does not say whether it must be taken with food.

Comes as

• •75 mg tablets: pink, round, film-coated tablets (debossed with 'E' on one side and '34' on the other)

⚠️ Clopidogrel side effects

🛑 Who should not take Clopidogrel, and who should be careful

The label says not to take it if

• 🚨You currently have a condition that causes active bleeding, such as a stomach ulcer, or intracranial hemorrhage (bleeding in the brain).
• 🚨You are allergic to clopidogrel or any other ingredient in clopidogrel tablets.

Tell your doctor before taking it if

• •Tell your doctor if you have a history of stomach or bowel ulcers.
• •Tell your doctor if you have a history of bleeding problems.
• •Tell your doctor and dentist that you take clopidogrel before any surgery, dental procedure, or invasive procedure. The label says your doctor may tell you to stop it at least 5 days before surgery.
• •Tell your doctor if you are pregnant or plan to become pregnant, or if you are breastfeeding or plan to breastfeed.
• •Tell your doctor if you have had an allergy or reaction to any medicine used to treat your condition.
• •Tell your doctor about all medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements.
• •The label says the medicine may not work as well in people with certain genetic factors that affect how the body breaks down clopidogrel. Your doctor may do genetic tests.
• •Keep a list of your medicines to show your doctor or pharmacist when you get a new medicine.

🔀 Clopidogrel with other medicines, food and alcohol

The label says to discuss these with your doctor or pharmacist

• •Omeprazole and esomeprazole: The label says to avoid taking these with clopidogrel because they significantly reduce its antiplatelet effect. The label says dexlansoprazole, lansoprazole, and pantoprazole had less effect. Your doctor may change your stomach acid medicine.
• •Strong CYP2C19 inducers, such as rifampin (used to treat severe infections): The label says to avoid these because they may increase the active form of clopidogrel and may increase bleeding risk.
• •Aspirin: Taken with clopidogrel for certain conditions, but it can increase bleeding risk. The label says to ask your doctor whether you should take aspirin with clopidogrel.
• •Nonsteroidal anti-inflammatory drugs (NSAIDs): These can increase bleeding risk. Ask your doctor or pharmacist for a list of NSAIDs if you are not sure.
• •Warfarin (Coumadin, Jantoven): Can increase bleeding risk.
• •Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs): Can increase bleeding risk. Ask your doctor or pharmacist for a list if you are not sure.
• •Other antiplatelet agents: Can increase bleeding risk.
• •Opioid pain medicines (such as morphine): The label says they can delay and reduce how well clopidogrel is absorbed. The label says doctors may consider a different antiplatelet medicine given by injection in some cases.
• •Repaglinide (Prandin): The label says clopidogrel may increase blood levels of this medicine.

Alcohol and food

The label does not say.

🤰 Clopidogrel in pregnancy and breastfeeding

Pregnancy

The label says it is not known whether clopidogrel will harm an unborn baby. Reports from published studies and after marketing have not identified drug-associated risks for major birth defects or miscarriage. The label also says heart attack and stroke are medical emergencies, and treatment for a pregnant woman should not be held back because of concerns about the fetus. The label says clopidogrel use during labor or delivery increases the risk of maternal bleeding. It says to avoid spinal or epidural procedures (neuraxial blockade) during clopidogrel use because of the risk of spinal hematoma. When possible, the label says clopidogrel should be stopped 5 to 7 days before delivery. Talk with your healthcare provider about your situation.

Breastfeeding

The label says it is not known whether clopidogrel passes into breast milk. The label says a decision should be made with your healthcare provider about whether to avoid or stop breastfeeding when continuing clopidogrel is needed.

🗓️ Storage, missed doses and taking too much

Storage

The label says to store clopidogrel at 20 to 25 degrees C (68 to 77 degrees F). Short temperature changes between 15 and 30 degrees C (59 to 86 degrees F) are allowed. Protect from moisture and keep in a well-closed container.

If a dose is missed

The label says to take a missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the next dose at your regular time. The label says not to take 2 doses at the same time unless your doctor tells you to.

If too much is taken

The label says that if you take too much clopidogrel, you should call your doctor or go to the nearest emergency room right away. Platelet inhibition from clopidogrel is irreversible and lasts for the life of each platelet, and an overdose may cause bleeding complications. The label says that, based on biological plausibility, a platelet transfusion may restore clotting ability.

🗒️ Questions to ask about Clopidogrel

• Should I have a genetic test to see how my body breaks down clopidogrel?
• Am I also supposed to take aspirin with clopidogrel, and for how long?
• Are any of my current medicines, including stomach acid medicines, a concern with clopidogrel?
• What should I do if I need surgery or a dental procedure while taking clopidogrel?
• What bleeding signs should prompt me to call you right away?
• What should I do if I miss a dose?
• What should I do if I think I took too much?

❓ Clopidogrel: frequently asked questions