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Clopidogrel (Plavix)

 

Taking clopidogrel helps prevent blood clots from forming in your arteries. This medicine helps reduce your risk of stroke or heart attack .

Plaque buildup in arteries

Clopidogrel may be used to:

  • Prevent or treat heart attacks
  • Prevent stroke or transient ischemic attacks , or TIAs (early warning signs of stroke also called "mini-strokes")
  • Increase blood flow to your legs
  • Prevent clots from forming inside stents put inside your arteries to open them

This medicine is taken as a pill. Your doctor may change your dose from time to time.

Alternate Names

Blood thinners - clopidogrel; Antiplatelet therapy - clopidogrel

Side Effects

Side effects of this medicine may include diarrhea, skin rash, itching, nausea, or stomach pain. Before you start taking clopidogrel, tell your doctor if:

  • You have bleeding problems or stomach ulcers .
  • You are pregnant, plan to become pregnant, or are breastfeeding.

Taking Clopidogrel

Take this medicine with food and plenty of water to lower side effects. You may need to stop taking clopidogrel before you have surgery or dental work. Do NOT just stop taking your medicine without talking with your doctor or nurse first.

Talk with your doctor before taking any of these drugs:

  • Heparin and other blood thinners, such as warfarin (Coumadin)
  • Pain or arthritis medicine (such as diclofenac, etodolac, ibuprofen, indomethacin, Advil, Aleve, Daypro, Dolobid, Feldene, Indocin, Motrin, Orudis, Relafen, or Voltaren)
  • Phenytoin (Dilantin), tamoxifen (Nolvadex, Soltamox), tolbutamide (Orinase), or torasemide (Demadex)

Do not take other drugs that may have aspirin or ibuprofen in them before taking with your doctor. Read the labels on cold and flu medicines. Ask your doctor what other medicines are safe for you to take for aches and pains, colds, or the flu.

Tell your doctor if you are pregnant or planning to become pregnant, or breastfeeding or planning to breastfeed. Women in the later stages of pregnancy should not take clopidogrel. Clopidogrel can also be passed to infants through breast milk.

If you miss a dose:

  • Take it as soon as possible, unless it is time for your next dose.
  • If it is time for your next dose, take your usual amount.
  • Do NOT take extra pills to make up for a dose you have missed, unless your doctor tells you to.

Store these drugs and all other medicines in a cool, dry place. Keep them where children cannot get to them.

When to Call the Doctor

Call your doctor if you have any of these side effects and they do not go away:

  • Any signs of unusual bleeding, such as blood in the urine or stools, nosebleeds, any unusual bruising, heavy bleeding from cuts, black tarry stools, coughing up blood, heavier than usual menstrual bleeding or unexpected vaginal bleeding, vomit that looks like coffee grounds
  • Dizziness
  • Difficulty swallowing
  • Tightness in your chest or chest pain
  • Swelling in your face or hands
  • Itching, hives, or tingling in your face or hands
  • Wheezing or difficulty breathing
  • Very bad stomach pain
  • Skin rash

References

Abraham NS, Hlatky MA, Antman EM, Bhatt DL, Bjorkman DJ, Clark CB, et al.ACCF/ACG/AHA 2010 Expert Consensus Document on the concomitant use of proton pump inhibitors and thienopyridines: a focused update of the ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. Circulation. 2010 Dec14;122(24):2619-33. Epub 2010 Nov 8. 

Fraker TD Jr, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation. 2007;116:2762-2772.

Kushner FG, Hand M, Smith SC Jr, King SB 3rd, Anderson JL, Antman EM, et al. 2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (updating the 2005 Guideline and 2007 Focused Update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2009 Dec 1;120(22):2271-306.  

Smith SC Jr, Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA, et al. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation endorsed by the World Heart Federation and the Preventive Cardiovascular Nurses Association. J Am Coll Cardiol. 2011 Nov 29;58(23):2432-46. Epub 2011 Nov 3.

Vandvik PO, Lincoff AM, Gore JM, Gutterman DD, Sonnenberg FA, Alonso-Coello P, et al. Primary and secondary prevention of cardiovascular disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):e637S-68S.

Lansberg MG, O'Donnell MJ, Khatri P, Lang ES, Nguyen-Huynh MN, Schwartz NE, et al. Antithrombotic and thrombolytic therapy for ischemic stroke: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2Suppl):e601S-36S. 

Updated: 8/28/2012

Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.


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