Clopidogrel Bisulfate (Hematological Agent)

Question 1

What is the brand name of Clopidogrel Bisulfate?

Answer 1

Plavix

Question 2

What tablet strengths are available for Plavix?

Answer 2

75mg & 300mg

Question 3

What is the recommended dose of Clopidogrel Bisulfate when being used to reduce atherosclerotic events in patients with atherosclerosis documented by stroke, recent myocardial infarction, or established peripheral arterial disease?

Answer 3

75mg QD with or without food

Question 4

What is the recommended dose of Plavix when being used to reduce atherosclerotic events in patients with acute coronary syndrome including unstable angina and non-Q-wave myocardial infarction?

Answer 4

Therapy should start with a 300mg loading dose, and then continued at 75mg QD. Aspirin 75mg-325mg should be initiated and continued in combination with clopidogrel. Most patients will also be treated acutely with heparin.

Question 5

What is the mechanism of action for Plavix?

Answer 5

Clopidogrel is converted by CYP2C19 to its active metabolite which inhibits platelet aggregation by irreversibly modifying platelet receptors, thereby selectively inhabiting the binding of adenosine diphosphate (ADP).

Question 6

What are the drug interactions of Clopidogrel?

Answer 6

• Use may predispose occult blood loss in patients taking NSAIDs
• Clopidogrel inhibits CYP2C9 enzyme, therefor it may interfere with the metabolism of phenytoin, tamoxifen, tolbutamide, warfarin, torsemide, fluvastatin, and NSAIDs
• Omeprazole and esomeprazole may decrease the effects of Clopidogrel

Question 7

What are the contraindications of Plavix?

Answer 7

• Contraindicated in active pathological bleeding such peptic ulcer or intracrhail hemorrhage
• Use with caution in patients who may be at risk of increased bleeding from trauma, surgery, or other pathological conditions
• Use with caution in patients with severe hepatic disease
• Rare cases of thrombotic thrombocytopenia pursuer (TTP) have been reported in patients taking clopidogrel
• Most TTP patients present with initial nonspecific complaints of fatigue, weakness, anorexia, nausea, diarrhea, and abdominal pain
• Clopidogrel is excreted in breast milk of studied rate
• DO NOT USE IN PATIENTS IDENTIFIED WITH TWO LOSS-OF-FUNCTION ALLELES OF THE CYP2C19 GENE
• Pregnancy Category B

Question 8

What are the adverse effects of Plavix?

Answer 8

• Upper respiratory tract infections
• Chest pain
• Headache
• Flu-like symptoms
• Arthralgia
• Dizziness
• Back pain
• Abdominal Pain
• Purpura
• Dyspepsia
• Rash
• HTN
• Edema
• Bronchitis
• Coughing
• UTI
• Pruritus
• Depression
• Nausea
• Epistaxis
• Fatigue

Question 9

Wha should the RPh tell the patient when counseling for Clopidogrel Bisulfate/Plavix?

Answer 9

• Consult physician if side effects are severe or persistent
• Contact physician if you notice any indication of infection
• Can be taken w/o regard to meals
• Bleeding time will be increased during therapy-report unusual bleeding to your MD
• Tell your MD & DMD about your therapy before elective surgeries
• Do not exceed prescribed dosage
• Do not take zOTC omeprazole products while on Clopidogrel
• If dose is missed, take it ASAP. If it is closer to the time of your next does than the does you missed, skip the missed dose. DO NOT double doses.