Clopidogrel: Difference between revisions
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==General==
==General==
*Type: [[Antiplatelet]]
*Type: [[Antiplatelet]]
*Dosage Forms: 75, 300 PO
*Dosage Forms: 75mg, 300mg PO
*Common Trade Names: Plavix
*Common Trade Names: Plavix


==Adult Dosing==
==Adult Dosing==
===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}}
| align="center" style="background:#f0f0f0;"|'''''
| align="center" style="background:#f0f0f0;"|'''Trial'''
| align="center" style="background:#f0f0f0;"|'''Age < 75'''
| align="center" style="background:#f0f0f0;"|'''Age > 75'''
|-
| [[STEMI]] with fibrinolysis||CLARITY||300 mg||75 mg
|-
| [[STEMI]] with PCI||OASIS-7||600 mg||300 mg
|-
| [[NSTEMI]]/[[Unstable angina|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==
==Pediatric Dosing==
*Not Recommended


==Special Populations==
==Special Populations==
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]:
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: B
*Lactation:
*Lactation: Safety Unknown
*Renal Dosing
*Renal Dosing
**Adult
**Adult: not defined
**Pediatric
**Pediatric
*Hepatic Dosing
*Hepatic Dosing
**Adult
**Adult: no adjustment
**Pediatric
**Pediatric


==Contraindications==
==Contraindications==
*Allergy to class/drug
*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==
==Adverse Reactions==
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*bleeding, severe,
*bleeding, severe,
*hemorrhage
*hemorrhage
*TTP
*[[TTP]]
*agranulocytosis
*agranulocytosis
*hypersensitivity rxn
*hypersensitivity reaction
*anaphylactoid rxn
*anaphylactoid reaction
*Stevens-Johnson syndrome
*[[Stevens-Johnson syndrome]]
*toxic epidermal necrolysis
*[[toxic epidermal necrolysis]]
*erythema multiforme
*[[erythema multiforme]]
*drug rash w/ eosinophilia and systemic sx
*drug rash with eosinophilia and systemic symptoms
*pneumonia, eosinophilic
*Eosinophilic pneumonia


===Common===
===Common===
*bleeding
*pruritus


==Pharmacology==
==Pharmacology==
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*Excretion: urine 50%, feces 46%
*Excretion: urine 50%, feces 46%
*Mechanism of Action: irreversibly binds to P2Y12 adenosine diphosphate receptors, reducing platelet activation and aggregation
*Mechanism of Action: irreversibly binds to P2Y12 adenosine diphosphate receptors, reducing platelet activation and aggregation
==Indications by Condition==
''The following table is automatically generated from disease/condition pages across WikEM.''
{{#ask:[[Has DrugName::Clopidogrel]]
|?Has Indication=Indication
|?Has Dose=Dose
|?Has Context=Context
|?Has Route=Route
|?Has Population=Population
|format=table
|headers=plain
|mainlabel=-
|sort=Has Indication
|limit=50
}}


==See Also==
==See Also==
*[[Antiplatelet medications]]
*[[Antiplatelet agent reversal]]


==Sources==
==References==
<references/>


<references/>
[[Category:Pharmacology]]
[[Category:Drugs]]

Latest revision as of 21:58, 20 March 2026

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

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

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


Indications by Condition

The following table is automatically generated from disease/condition pages across WikEM.

IndicationDoseContextRoutePopulation
ST-segment elevation myocardial infarction600 mg PO loading (if PCI anticipated); 300 mg PO loading otherwiseP2Y12 antiplatelet (loading dose)POAdult
Transient ischemic attack300mg PO load, then 75mg daily x 3 weeksDual antiplatelet for high-risk TIA (ABCD2 >= 4)POAdult

See Also

References

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ 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.
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