Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
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.
Clopidogrel is activated by enzymes in the liver. Individuals who have reduced activity of liver enzymes that activate clopidogrel may not adequately respond to clopidogrel. Alternative treatments should be used for these patients.
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.
Clopidogrel is converted to its active form by enzymes in the liver. Drugs that reduce the activity of these enzymes (for
example, omeprazole [Prilosec,
Zegerid], esomeprazole
[Nexium]) may reduce the activity of clopidogrel and should not be used with clopidogrel. Other drugs that also may react with clopidogrel in a similar fashion include fluoxetine
(Prozac, Sarafem), cimetidine
(Tagamet), fluconazole
(Diflucan), ketoconazole (Nizoral, Extina, Xolegel, Kuric), voriconazole
(Vfend), ethaverine
(Ethatab, Ethavex), felbamate (Felbatol), and fluvoxamine
(Luvox).
A stroke results from impaired oxygen delivery to brain cells via the bloodstream. A stroke is also referred to as a CVA, or cerebrovascular incident. Symptoms of stroke include: sudden numbness or weakness of the face, arm or leg. Sudden confusion, trouble speaking or understanding. Sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, or loss of balance, and/or sudden severe headache with no known cause. A TIA, or transient ischemic attack is a short-lived temporary impairment of the brain caused by loss of blood supply. Stroke is a medical emergency.
Heart attack happens when a blood clot completely obstructs a coronary
artery supplying blood to the heart muscle. A heart attack can cause chest pain, heart failure, and electrical
instability of the heart.
Internal bleeding occurs when an artery or vein is damaged and blood to escapes the circulatory system and collects inside the body. Internal bleeding can be caused by a variety of situations such as blunt trauma, deceleration trauma, medications, fractures, and spontaneous bleeding. Treatment of internal bleeding depends on the cause of the bleeding.
When a portion of the brain loses blood supply, through a blood clot or embolus, a transient ischemic attack (TIA, mini-stroke) may occur. If the symptoms do not resolve, a stroke most likely has occurred. Symptoms of TIA include: confusion, weakness, lethargy, and loss of function to one side of the body. Risk factors for TIA include vascular disease, smoking, high blood pressure, high cholesterol, and diabetes. Treatment depends upon the severity of the TIA, and whether it resolves.
Heart attacks are the major causes of unexpected, sudden death among men and women. A heart attack is also a significant cause of heart failure. Learn the risk factors for heart attack such as high blood pressure, diabetes, and other heart conditions. Lowering your risk factor, lifestyle changes, and in some cases medication are the most effective way of preventing a heart attack.
While the general public understands that internal
bleeding means bleeding that can't be seen on the outside of the body, medical
personnel tend to use terms that describe precisely where inside the body the
bleeding is found. The internal bleeding may occur within tissues, organs, or in
cavities of the body including the head, chest, and abdomen. Examples of other
potential sites of bleeding include the eye, lining tissues of the heart, muscles, and joints.
Bleeding outside the body is quite easy to recognize. If the skin is damaged by
a laceration,
puncture, or abrasion, blood can
be witnessed as it streams out of the body. The scalp, with its rich blood
supply, is notorious for demonstrating massive blood loss. Internal bleeding can
be much more difficult to identify. It may not be evident for many hours after
it begins, and symptoms occur when there is significant blood loss or if a
blood
clot is large eno...
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