Class
- Antiplatelet agent
Clopidogrel
Commonly Prescribed for
(FDA approved in bold)
- Recent myocardial infarction (MI), recent ischemic stroke, or established peripheral arterial disease as secondary prevention
- Acute coronary syndrome
- Prevention of cardiac events as loading dose in patients receiving coronary stent implantation
Clopidogrel
How the Drug Works
- Inhibitor of platelet aggregation. Clopidogrel works by irreversibly modifying the platelet adenosine diphosphate (ADP) receptor and inhibits the activation of the GPIIb/IIIa complex
Clopidogrel
How Long Until It Works
- Inhibition of platelet aggregation begins as soon as 2 hours after a single oral dose of clopidogrel. Reaches steady state between days 3–7
Clopidogrel
If It Works
- Continue to use for MI or stroke prevention
Clopidogrel
If It Doesn’t Work
- Patients can still have MI or stroke despite treatment. Warfarin is superior for cardiogenic stroke. Control all stroke risk factors such as smoking, hyperlipidemia, and hypertension. For acute events, admit patients for treatment and diagnostic testing
Clopidogrel
Best Augmenting Combos for Partial Response or Treatment-Resistance
- In stroke prevention, there is no proven benefit to using clopidogrel in combination with aspirin. In clinical trials there was no significant difference in stroke prevention, and AEs (mostly bleeding) were significantly higher
Clopidogrel
Tests
- None required
Adverse Effects (AEs)
Clopidogrel
How Drug Causes AEs
- Antiplatelet effect increases bleeding risk
Clopidogrel
Notable AEs
- Nausea, vomiting, rash, diarrhea
Clopidogrel
Life-Threatening or Dangerous AEs
- GI hemorrhage occurred in about 2% of stroke patients in clinical trials (with 0.7% requiring hospitalization), intracranial hemorrhage (0.4%), or intraocular bleeding leading to vision loss
Clopidogrel
Weight Gain
- Unusual
Clopidogrel
Sedation
- Unusual
Clopidogrel
What to Do About AEs
- For significant GI or intracranial bleeding, stop drug
Clopidogrel
Best Augmenting Agents for AEs
- Most AEs cannot be improved by an augmenting agent
Dosing and Use
Clopidogrel
Usual Dosage Range
- 75 mg daily
Clopidogrel
Dosage Forms
- Tablets: 75 mg
Clopidogrel
How to Dose
- Give once daily. Occasionally used off-label as a loading dose of 300 mg after coronary or intracranial stenting, followed by daily use at 75 mg
