Clopidogrel

Aka: Clopidogrel, Plavix, Thienopyridine, Thiophene, Prasugrel, Effient

1. See Also
   1. Antiplatelet Therapy for Vascular Disease
2. Mechanism: Thienopyridine Class
   1. Blocks Platelet ADP
   2. Inhibits platelet aggregation
3. Indications
   1. Cerebrovascular Accident Prevention
   2. Coronary Artery Disease Prevention
   3. Post-ST Elevation MI (with or without perfusion)
4. Preparations
   1. Clopidogrel (Plavix)
   2. Prasugrel (Effient)
      1. More effective than Plavix in cardiovascular event reduction
      2. Higher risk of bleeding than Plavix in age >75 years, weight <60 kg, CVA history
      3. Wiviott (2007) N Engl J Med 357(20):2001-15
5. Advantages: Clopidogrel
   1. Plavix will be generic in 2012
   2. Less adverse effects than Ticlid
   3. Less GI Bleeding than Aspirin
      1. Option if GI Bleeding occurs with Aspirin
      2. Switch to Plavix does not prevent recurrent GI Bleed
         1. GI Bleed occurs in 8% of those switched to Plavix
         2. Consider adding PPI to Aspirin instead of Plavix
6. Disadvantages
   1. Expensive
7. Dosing
   1. Plavix 75 mg orally daily (consider initial 300 mg loading dose if age <75 years)
8. Drug Interactions
   1. Proton Pump Inhibitors
      1. Risk: Omeprazole and Esomeprazole reduce conversion of Plavix to active metabolite (unclear clinical impact)
      2. Safe: Lansoprazole, Dexlansoprazole, Pantoprazole and Famotidine (high dose) do not appear to interact with Plavix
      3. Limit Proton Pump Inhibitors for high risk (prior GI Bleed, advanced age, concurrent Aspirin, NSAIDs, Corticosteroids, or Warfarin)
      4. Mehta (2011) Clin Cardiol 34(9): 528-31