Drug NamePlavix (Clopidogrel) Drug UsesClopidogrel is used to prevent strokes and heart attacks in persons who are at high risk. In one large study, clopidogrel was more effective than aspirin in reducing heart attacks. The frequency of side effects of clopidogrel was similar to aspirin; however, stomach and intestinal bleeding probably occurs less often with clopidogrel than with aspirin. How to useTake clopidogrel exactly as directed by your doctor. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you. Take each dose with a full glass of water. Clopidogrel can be taken with or without food. Drug Class and MechanismClopidogrel is an anti-platelet drug, that is, a drug that inhibits the ability of platelets to clump together as part of a blood clot. It is similar to ticlopidine (Ticlid) in chemical structure and in the way it works. Unlike ticlopidine, clopidogrel does not cause serious reductions of white cells in the blood and, therefore, routine blood testing to determine if the white blood cell count is low is not necessary during treatment. The risk of heart attacks and strokes (which usually are caused by blood clots) is increased in patients with a recent history of stroke or heart attack and patients with peripheral vascular disease. (Peripheral vascular disease is the same as atherosclerotic arterial disease or "hardening" of the arteries in which the arteries become narrowed. It frequently occurs in the legs and often causes claudication or pain in the legs upon walking). Clopidogrel is used to reduce the risk of heart attacks and strokes in these patients. Clopidogrel was approved by the FDA in 1997. Missed DoseTake the missed dose as soon as you remember. However, if it is almost time for the next dose, skip the missed dose and take only the next regularly scheduled dose. Do not take a double dose of this medication. Storage Tablets should be stored at room temperature, 15-30 degrees C (59-86 degrees F), away from moisture and heat. Possible Side EffectsThe tolerability of clopidogrel is similar to that of aspirin. Diarrhea, rash, or itching occurs in approximately 1 in 20 persons taking clopidogrel. Abdominal pain also occurs in about 1 in 20 persons, but it is less frequent than with aspirin.
Ticlopidine (Ticlid) is an antiplatelet medication quite similar to clopidogrel. It has been associated with a severe reduction in white blood cell count in between 0.8% and 1% of persons. The risk of this dangerous side effect with clopidogrel is about 0.04%, much less than with ticlopidine but twice that of aspirin.
Clopidogrel rarely causes a condition called thrombotic thrombocytopenic purpura (TTP) in one out of every 250,000 people. TTP is a serious condition in which blood clots form throughout the body. Blood platelets, which participate in clotting, are consumed, and the result can be bleeding because enough platelets are no longer left to allow blood to clot normally. For comparison, the related drug, ticlodipine (Ticlid), causes TTP 17-50 times more frequently than clopidogrel. More Information
- If you experience any of the following serious side effects, stop taking clopidogrel and seek emergency medical attention or notify your doctor immediately:
- an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives);
- bloody (or black) vomit or stools;
- severe headache, confusion, or dizziness;
- unexplained bruising or bleeding; or
- bleeding nose.
- Other, less serious side effects may be more likely to occur. Continue to take clopidogrel and talk to your doctor if you experience
- upset stomach;
- diarrhea or constipation; or
- headache or dizziness.
- Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
Warnings/PrecautionsTell your doctor and dentist that you are taking this medication before having any surgical procedures. Do not take aspirin, ibuprofen (Motrin, Advil, Nuprin, others), naproxen (Aleve, Anaprox, Naprosyn, others), ketoprofen (Orudis, Orudis KT, Oruvail), indomethacin (Indocin), nabumetone (Relafen), oxaprozin (Daypro), or other non-steroidal anti-inflammatory medications (NSAIDs) without first talking to your doctor. It may take longer than usual for you to stop bleeding, even from minor wounds. Tell your doctor about any unusual bleeding or bruising that you experience. Studies in rats have shown that clopidogrel appears in breast milk; however, it is not known whether it also appears in human breast milk. Because of a potential for side effects in the nursing infant, the physician must weigh the potential benefits and possible risks before prescribing clopidogrel in nursing mothers.
What is clopidogrel?
Clopidogrel keeps the platelets in your blood from coagulating (clotting) to prevent unwanted blood clots that can occur with certain heart or blood vessel conditions.
Clopidogrel is used to prevent blood clots after a recent heart attack or stroke, and in people with certain disorders of the heart or blood vessels.
Clopidogrel may also be used for other purposes not listed in this medication guide.
What is the most important information I should know about clopidogrel?
Clopidogrel keeps your blood from coagulating (clotting) to prevent unwanted blood clots that can occur with certain heart or blood vessel conditions. Because of this drug action, clopidogrel can make it easier for you to bleed, even from a minor injury. Contact your doctor or seek emergency medical attention if you have bleeding that will not stop.
You may also have bleeding on the inside of your body, such as in your stomach or intestines. Call your doctor at once if you have black or bloody stools, or if you cough up blood or vomit that looks like coffee grounds. These could be signs of bleeding in your digestive tract. Avoid drinking alcohol while taking clopidogrel. Alcohol may increase your risk of bleeding in your stomach or intestines.
If you need to have any type of surgery or dental work, tell the surgeon or dentist ahead of time that you are using clopidogrel. You may need to stop using the medicine for at least 5 days before having surgery, to prevent excessive bleeding.
While you are taking clopidogrel, do not take aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs) without your doctor's advice. NSAIDs include ibuprofen (Motrin, Advil), naproxen (Aleve, Naprosyn), diclofenac (Voltaren), diflunisal (Dolobid), etodolac (Lodine), flurbiprofen (Ansaid), indomethacin (Indocin), ketoprofen (Orudis), ketorolac (Toradol), mefenamic acid (Ponstel), meloxicam (Mobic), nabumetone (Relafen), piroxicam (Feldene), and others.
What should I discuss with my healthcare provider before taking clopidogrel?
Do not use this medication if you are allergic to clopidogrel, or if you have any active bleeding such as a stomach ulcer or bleeding in the brain (such as from a head injury).
Before taking clopidogrel, tell your doctor if you are allergic to any drugs, or if you have:
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a bleeding or blood clotting disorder, such as hemophilia;
-
a history of stroke, including TIA ("mini-stroke");
-
a stomach ulcer or ulcerative colitis;
-
liver disease; or
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kidney disease.
If you have any of these conditions, you may need a dose adjustment or special tests to safely take this medication.
FDA pregnancy category B. This medication is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether clopidogrel passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.
How should I take clopidogrel?
Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.
Take this medication with a full glass of water.
Clopidogrel can be taken with or without food.
Because clopidogrel keeps your blood from coagulating (clotting) to prevent unwanted blood clots, it can also make it easier for you to bleed, even from a minor injury. Contact your doctor or seek emergency medical attention if you have bleeding that will not stop.
To be sure this medication is not causing harmful effects, your blood will need to be tested on a regular basis. Do not miss any scheduled visits to your doctor.
Store clopidogrel at room temperature away from moisture and heat.
What happens if I miss a dose?
Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at your next regularly scheduled time. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention if you think you have used too much of this medicine.
Overdose symptoms may include vomiting, feeling exhausted or short of breath, and blood in your stools or vomit.
What should I avoid while taking clopidogrel?
While you are taking clopidogrel, do not take aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs) without your doctor's advice. NSAIDs include ibuprofen (Motrin, Advil), naproxen (Aleve, Naprosyn), diclofenac (Voltaren), diflunisal (Dolobid), etodolac (Lodine), flurbiprofen (Ansaid), indomethacin (Indocin), ketoprofen (Orudis), ketorolac (Toradol), mefenamic acid (Ponstel), meloxicam (Mobic), nabumetone (Relafen), piroxicam (Feldene), and others.
Avoid sports or activities that could result in a bruising or bleeding injury. Use extra caution to avoid cuts when brushing your teeth or shaving.
Avoid drinking alcohol while taking clopidogrel. Alcohol may increase your risk of bleeding in your stomach or intestines.
Clopidogrel side effects
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using clopidogrel and call your doctor at once if you have any of these serious side effects:
-
nosebleed or other bleeding that will not stop;
-
black, bloody, or tarry stools;
-
coughing up blood or vomit that looks like coffee grounds;
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chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling;
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sudden numbness or weakness, especially on one side of the body;
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sudden headache, confusion, problems with vision, speech, or balance; or
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pale skin, easy bruising or bleeding, weakness, fever, and urinating more or less than usual.
Less serious side effects may include:
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stomach pain;
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runny or stuffy nose, cough, sore throat; or
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mild headache or dizziness.
This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.
What other drugs will affect clopidogrel?
Before taking clopidogrel, tell your doctor if you are using any of the following drugs:
-
phenytoin (Dilantin);
-
tamoxifen (Nolvadex);
-
tolbutamide (Orinase);
-
torsemide (Demadex);
-
fluvastatin (Lescol);
-
a blood thinner such as warfarin (Coumadin), heparin, ardeparin (Normiflo), dalteparin (Fragmin), danaparoid (Orgaran), enoxaparin (Lovenox), or tinzaparin (Innohep); or
-
medication used to prevent blood clots, such as alteplase (Activase), anistreplase (Eminase), dipyridamole (Persantine), streptokinase (Kabikinase, Streptase), ticlopidine (Ticlid), and urokinase (Abbokinase).
This list is not complete and there may be other drugs that can interact with clopidogrel. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.
Where can I get more information?
- Your pharmacist can provide more information about clopidogrel.
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