Medications and Drugs
GENERIC NAME: clopidogrel bisulfate
BRAND NAME: Plavix
DRUG CLASS AND MECHANISM: Clopidogrel bisulfate 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 bisulfate 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
bisulfate is used to reduce
the risk of heart attacks and strokes in these patients. Clopidogrel bisulfate was
approved by the FDA in 1997.
GENERIC AVAILABLE: no
PRESCRIPTION: yes
PREPARATIONS: Tablets: 75mg.
STORAGE: Tablets should be stored at room temperature,
15-30°C (59-86°F).
PRESCRIBED FOR: Clopidogrel is used to prevent strokes and heart
attacks in persons who are at high risk. In one large
study, clopidogrel bisulfate was more effective than aspirin in reducing heart
attacks. The frequency of side effects of clopidogrel bisulfate was similar to aspirin; however, stomach and intestinal bleeding probably occurs less often with clopidogrel
bisulfate than with aspirin.
DOSING: Clopidogrel bisulfate usually is taken once daily. It can be taken
with or without food.
DRUG INTERACTIONS: The combination of clopidogrel with
nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin; Advil;
Nuprin), naproxen (Naprosyn, Aleve), diclofenac (Voltaren), etodolac (Lodine), nabumetone
(Relafen), fenoprofen (Nalfon), flurbiprofen (Ansaid), indomethacin (Indocin), ketoprofen (Orudis; Oruvail), oxaprozin (),
piroxicam (Feldene), sulindac (Clinoril), tolmetin (Tolectin), and mefenamic
acid (Ponstel) may increase the risk of stomach and intestinal bleeding.
At high concentrations in the blood, clopidogrel inhibits the activity of the enzyme
which metabolizes (eliminates) warfarin (Coumadin), a "blood thinner". This could lead to an increase in levels of warfarin and increase the risk of bleeding due to over-thinning of the blood. To date there have been no reports
of an important interaction in humans between warfarin and clopidogrel. Nonetheless, because warfarin increases
the risk of bleeding, blood tests to measure the degree to which the blood is anti-coagulated or thinned (prothrombin time; INR) may be ordered to
assess the degree of blood-thinning when warfarin and clopidogrel are used together. The same enzyme also is
responsible for the metabolism of phenytoin (Dilantin), tamoxifen (Nolvadex), tolbutamide
(Orinase), torsemide (Demadex), and fluvastatin (Lescol).
Although important interactions between clopidogrel and these drugs are
unlikely, interactions should be looked for carefully.
There have been several reports that proton pump inhibitors--omeprazole
(Prilosec, Zegerid, ), pantoprazole (Protonix), esomeprazole (Nexium),
rabeprazole (Aciphex) and lansoprazole (Prevacid)--may reduce the
effect of clopidogrel because they reduce the conversion of clopidogrel to its
active form in the body. Although further studies are needed to clarify
whether this interaction is important, the FDA recommends that patients taking clopidogrel should avoid proton pump inhibitors unless they are necessary.
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
- Drug Interactions - Learn about potential drug interactions you may be exposed to. Drug interactions can occur with prescription drugs, OTC medication, vitamins, herbs, and supplements.
- Stroke - Learn about strokes symtoms like sudden numbness or weakness in the face, arms, or legs, confusion, vision problems, problems with walking or coordination, or severe headache.
- Drugs: What You Should Know About Your Drugs - Find out what you should know about your drugs such as side effects, warnings and precautions, storage information, and if a generic version is as good as the brand name.
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