Clopidogrel

General

• Type: Antiplatelet
• Dosage Forms: 75, 300 PO
• Common Trade Names: Plavix

Adult Dosing

Acute coronary syndrome

• Unstable angina, NSTEMI: Start 300 mg PO x 1, then 75 mg PO qd
• STEMI: 75 mg/day PO (in combination with aspirin 162-325 mg/day
• Recent MI, Stroke, or Peripheral Arterial Disease: 75 mg PO qd

Thrombotic event prevention

• 75 mg 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 w/in 5 days
• caution if GI disorder
• caution if ocular dz
• 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 sx
• 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