Clopidogrel: Difference between revisions
(/* Age and Indication Related DosagesSabatine MS et al. Addition of Clopidogrel to Aspirin and Fibrinolytic Therapy for Myocardial Infarction with ST-Segment Elevation. N Engl J Med 2005; 352:1179-1189.Mehta SR et al. Double-dose versus standard-dose c...) |
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==General== | ==General== | ||
*Type: [[Antiplatelet]] | *Type: [[Antiplatelet]] | ||
*Dosage Forms: | *Dosage Forms: 75mg, 300mg PO | ||
*Common Trade Names: Plavix | *Common Trade Names: Plavix | ||
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===Age and Indication Related Dosages<ref>Sabatine MS et al. Addition of Clopidogrel to Aspirin and Fibrinolytic Therapy for Myocardial Infarction with ST-Segment Elevation. N Engl J Med 2005; 352:1179-1189.</ref><ref>Mehta SR et al. Double-dose versus standard-dose clopidogrel and high-dose versus low-dose aspirin in individuals undergoing percutaneous coronary intervention for acute coronary syndromes (CURRENT-OASIS 7): a randomised factorial trial. Lancet. 2010 Oct 9;376(9748):1233-43.</ref><ref>The Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators. Effects of Clopidogrel in Addition to Aspirin in Patients with Acute Coronary Syndromes without ST-Segment Elevation. N Engl J Med 2001; 345:494-502.</ref>=== | ===Age and Indication Related Dosages<ref>Sabatine MS et al. Addition of Clopidogrel to Aspirin and Fibrinolytic Therapy for Myocardial Infarction with ST-Segment Elevation. N Engl J Med 2005; 352:1179-1189.</ref><ref>Mehta SR et al. Double-dose versus standard-dose clopidogrel and high-dose versus low-dose aspirin in individuals undergoing percutaneous coronary intervention for acute coronary syndromes (CURRENT-OASIS 7): a randomised factorial trial. Lancet. 2010 Oct 9;376(9748):1233-43.</ref><ref>The Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators. Effects of Clopidogrel in Addition to Aspirin in Patients with Acute Coronary Syndromes without ST-Segment Elevation. N Engl J Med 2001; 345:494-502.</ref>=== | ||
{| {{table}} | {| {{table}} | ||
| align="center" style="background:#f0f0f0;"| | | align="center" style="background:#f0f0f0;"|''''' | ||
| align="center" style="background:#f0f0f0;"|'''Trial''' | | align="center" style="background:#f0f0f0;"|'''Trial''' | ||
| align="center" style="background:#f0f0f0;"|'''Age < 75''' | | align="center" style="background:#f0f0f0;"|'''Age < 75''' | ||
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===Post-[[Acute coronary syndrome]]=== | ===Post-[[Acute coronary syndrome]]=== | ||
*[[Unstable angina]], [[NSTEMI]]: Start 300mg PO x 1, then 75mg PO | *[[Unstable angina]], [[NSTEMI]]: Start 300mg PO x 1, then 75mg PO QD | ||
*[[STEMI]]: 75mg/day PO (in combination with [[aspirin]] 162-325mg/day | *[[STEMI]]: 75mg/day PO (in combination with [[aspirin]] 162-325mg/day | ||
*Recent MI, [[Stroke]], or [[Peripheral Arterial Disease]]: 75mg PO | *Recent MI, [[Stroke]], or [[Peripheral Arterial Disease]]: 75mg PO QD | ||
===Thrombotic event prevention=== | ===Thrombotic event prevention=== | ||
*75mg PO | *75mg PO QD | ||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
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*[[toxic epidermal necrolysis]] | *[[toxic epidermal necrolysis]] | ||
*[[erythema multiforme]] | *[[erythema multiforme]] | ||
*drug rash with eosinophilia and systemic | *drug rash with eosinophilia and systemic symptoms | ||
*Eosinophilic pneumonia | *Eosinophilic pneumonia | ||
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==See Also== | ==See Also== | ||
*[[Antiplatelet medications]] | |||
*[[Antiplatelet agent reversal]] | |||
==References== | ==References== | ||
<references/> | |||
[[Category:Pharmacology]] | [[Category:Pharmacology]] | ||
Latest revision as of 02:48, 6 March 2021
General
- Type: Antiplatelet
- Dosage Forms: 75mg, 300mg PO
- Common Trade Names: Plavix
Adult Dosing
Age and Indication Related Dosages[1][2][3]
| Trial | Age < 75 | Age > 75 | |
| STEMI with fibrinolysis | CLARITY | 300 mg | 75 mg |
| STEMI with PCI | OASIS-7 | 600 mg | 300 mg |
| NSTEMI/UA with ischemic EKG changes | CURE | 300 mg | 75 mg |
Post-Acute coronary syndrome
- Unstable angina, NSTEMI: Start 300mg PO x 1, then 75mg PO QD
- STEMI: 75mg/day PO (in combination with aspirin 162-325mg/day
- Recent MI, Stroke, or Peripheral Arterial Disease: 75mg PO QD
Thrombotic event prevention
- 75mg PO QD
Pediatric Dosing
- Not Recommended
Special Populations
- Pregnancy Rating: B
- Lactation: Safety Unknown
- Renal Dosing
- Adult: not defined
- Pediatric
- Hepatic Dosing
- Adult: no adjustment
- Pediatric
Contraindications
- Allergy to class/drug
- active bleeding
- caution if trauma
- caution if elective surgery within 5 days
- caution if GI disorder
- caution if ocular disease
- caution if poor or intermediate CYP2C19 metabolizer
- caution if renal impairment, mod-severe
Adverse Reactions
Serious
- bleeding, severe,
- hemorrhage
- TTP
- agranulocytosis
- hypersensitivity reaction
- anaphylactoid reaction
- Stevens-Johnson syndrome
- toxic epidermal necrolysis
- erythema multiforme
- drug rash with eosinophilia and systemic symptoms
- Eosinophilic pneumonia
Common
- bleeding
- pruritus
Pharmacology
- Half-life: 8h
- Metabolism: liver, CYP450: 1A2, 2C9, 2C19 (primary), 3A4 substrate
- Excretion: urine 50%, feces 46%
- Mechanism of Action: irreversibly binds to P2Y12 adenosine diphosphate receptors, reducing platelet activation and aggregation
See Also
References
- ↑ Sabatine MS et al. Addition of Clopidogrel to Aspirin and Fibrinolytic Therapy for Myocardial Infarction with ST-Segment Elevation. N Engl J Med 2005; 352:1179-1189.
- ↑ Mehta SR et al. Double-dose versus standard-dose clopidogrel and high-dose versus low-dose aspirin in individuals undergoing percutaneous coronary intervention for acute coronary syndromes (CURRENT-OASIS 7): a randomised factorial trial. Lancet. 2010 Oct 9;376(9748):1233-43.
- ↑ The Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators. Effects of Clopidogrel in Addition to Aspirin in Patients with Acute Coronary Syndromes without ST-Segment Elevation. N Engl J Med 2001; 345:494-502.