CLOPIDOGREL

Indications & Dose:

Prevention of atherothrombotic events in percutaneous coronary intervention (adjunct with aspirin) in patients not already on clopidogrel

• BY MOUTH

Adult: Loading dose 300 mg, to be taken prior to the procedure, alternatively loading dose 600 mg, higher dose may produce a greater and more rapid inhibition of platelet aggregation

Transient ischaemic attack for patients with aspirin hypersensitivity, or those intolerant of aspirin despite the addition of a proton pump inhibitor | Acute ischaemic stroke for patients with aspirin hypersensitivity, or those intolerant of aspirin despite the addition of a proton pump inhibitor

• By MOUTH

Adult: 75 mg once daily

Prevention of atherothrombotic events in peripheral arterial disease or within 35 days of myocardial infarction, or within 6 months of ischaemic stroke

• BY MOUTH

Adult: 75 mg once daily

Prevention of artherothrombotic events in acute coronary syndrome without ST-segment elevation (given with aspirin)

• BY MOUTH

Adult: Initially 300 mg, then 75 mg daily for up to 12 months continued.

Prevention of artherothrombotic events in acute myocardial infarction with ST-segment elevation (given with aspirin)

• BY MOUTH

Adult 18–75 years: Initially 300 mg, then 75 mg for at least 4 weeks

Adult 76 years and over: 75 mg daily for at least 4 weeks

Prevention of atherothrombotic and thromboembolic events in patients with atrial fibrillation and at least one risk factor for a vascular event (with aspirin) and for whom warfarin is unsuitable

• BY MOUTH

Adult: 75 mg once daily 

Contraindications:

Active pathological bleeding; coagulation disorders; patients receiving anticoagulants or other antiplatelet agents

Side Effects:

Cautions:

Precautions:

Previous hypersensitivity or other untoward effects related to ticlopidine; hypertension; hepatic or renal impairment; history of bleeding or hemostatic disorders; history of drug related hematologic disorders; patients scheduled for major surgery; pregnancy

Interaction:

Drugs

 Fluvastatin: Inhibition of hepatic metabolism of fluvastatin with increased risk of myositis; in vitro data

Nonsteroidal antiinflammatory agents: Increased bleeding risk

Phenytoin: Inhibition of hepatic metabolism of phenytoin and increased risk of toxicity; in vitro data

Tamoxifen: Inhibition of hepatic metabolize ( and increased tamoxifen effects; in vitro data

Tolbutamide: Inhibition of hepatic metabolism of tolbutamide with increased risk of hypoglycemia; in vitro data

Torsemide: Inhibition of hepatic metabolism of torsemide with enhanced diuretic effects; in vitro data; increased bleeding risk

Warfarin: Inhibition of hepatic metabolism of warfarin with enrvanced hypoprothrombinemic effects; in vitro data; increased bleeding risk

Warnings:

Adverse Effects:

Lactations:

Pregnancy category B; excreted into breast milk in rats

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

CNS: Dizziness, headache, intracranial bleeding

CV: Hypertension

GI: Abdominal pain, diarrhea, dyspepsia, GI ulceration and hemorrhage, nausea

GU: Liver enzyme elevation

HEME: Neutropenia (uncommon), prolonged bleeding time, purpura

SKIN: Pruritus, rash, urticaria

Patient And Carer Advice: