Clopidogrel: Difference between revisions
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==General== | ==General== | ||
*Type: [[Antiplatelet]] | *Type: [[Antiplatelet]] | ||
*Dosage Forms: | *Dosage Forms: 75, 300 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== | ||
===Serious=== | ===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=== | ===Common=== | ||
*bleeding | |||
*pruritus | |||
==Pharmacology== | ==Pharmacology== | ||
*Half-life: | *Half-life: 8h | ||
*Metabolism: | *Metabolism: liver, CYP450: 1A2, 2C9, 2C19 (primary), 3A4 substrate | ||
*Excretion: | *Excretion: urine 50%, feces 46% | ||
*Mechanism of Action: | *Mechanism of Action: irreversibly binds to P2Y12 adenosine diphosphate receptors, reducing platelet activation and aggregation | ||
==See Also== | ==See Also== | ||
==References== | |||
<references/> | <references/> | ||
[[Category: | |||
[[Category:Pharmacology]] |
Revision as of 06:29, 13 July 2017
General
- Type: Antiplatelet
- Dosage Forms: 75, 300 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.