General

Pronunciation
kloh-PID-oh-grel

Trade Name(s)

• Plavix

Pregnancy Category
Category B

Ther. class.
antiplatelet agents

Pharm. class.
platelet aggregation inhibitors

Indications

Reduction of atherosclerotic events (MI, stroke, vascular death) in patients at risk for such events including recent MI, acute coronary syndrome (unstable angina/non–Q-wave MI), stroke, or peripheral vascular disease

Action

Inhibits platelet aggregation by irreversibly inhibiting the binding of ATP to platelet receptors

Therapeutic Effect(s):
Decreased occurrence of atherosclerotic events in patients at risk

Pharmacokinetics

Absorption: Well absorbed following oral administration; rapidly metabolized to an active antiplatelet compound. Parent drug has no antiplatelet activity.

Distribution: Unknown

Protein Binding: Clopidogrel—98%;active metabolite— 94%

Metabolism and Excretion: Rapidly and extensively converted by the liver to its active metabolite, which is then eliminated 50% in urine and 45% in feces

Half-life: 8 hr (active metabolite)

TIME/ACTION PROFILE (effects on platelet function)

ROUTE	ONSET	PEAK	DURATION
PO	within 24 hr	3–7 days	5 days†

†Following discontinuation

Contraindication/Precautions

Contraindicated in:

• Hypersensitivity

• Pathologic bleeding (peptic ulcer, intracranial hemorrhage)

• Lactation

Use Cautiously in:

• Patients at risk for bleeding (trauma, surgery, or other pathologic conditions)

• History of GI bleeding/ulcer disease

• Severe hepatic impairment

• OB: Lactation: Pedi: Safety not established; use in pregnancy only if clearly indicated

Adverse Reactions/Side Effects

Incidence of adverse reactions similar to that of aspirin

CNS: depression, dizziness, fatigue, headache.

EENT: epistaxis.

Resp: cough, dyspnea.

CV: chest pain, edema, hypertension.

GI: GI BLEEDING, abdominal pain, diarrhea, dyspepsia, gastritis.

Derm: pruritus, purpura, rash.

Hemat: BLEEDING, NEUTROPENIA, THROMBOTIC THROMBOCYTOPENIC PURPURA.

Metabolic: hypercholesterolemia.

MS: arthralgia, back pain.

Misc: fever, hypersensitivity reactions.

*CAPITALS indicates life-threatening.
*italic indicates most frequent.

Interactions

Drug-Drug

• Concurrent abciximab, eptifibatide, tirofiban, aspirin, NSAIDs, heparin, heparanoids, thrombolytic agents, ticlopidine, or warfarin may risk of bleeding

• May metabolism and effects of phenytoin, tolbutamide, tamoxifen, torsemide, fluvastatin, and many NSAIDs

Drug-Natural Products
bleeding risk with anise, arnica, chamomile, clove, fenugreek, feverfew, garlic, ginger, ginkgo, Panax ginseng, and others

Route/Dosage

Recent MI, Stroke, or Peripheral Vascular Disease

• PO (Adults): 75 mg once daily.

Acute Coronary Syndrome

• PO (Adults): 300 mg initially, then 75 mg once daily; aspirin 75–325 mg once daily should be given concurrently.

Availability

• Tablets: 75 mg, 300 mg

» Cost: $389.68/90.

Assessment

• Assess patient for symptoms of stroke, peripheral vascular disease, or MI periodically during therapy

• Monitor patient for signs of thrombotic thrombocytic purpura (thrombocytopenia, microangiopathic hemolytic anemia, neurologic findings, renal dysfunction, fever). May rarely occur, even after short exposure (<2 wk). Requires prompt treatment

Lab Test Considerations

• Monitor bleeding time during therapy. Prolonged bleeding time, which is time- and dose-dependent, is expected

» Monitor CBC with differential and platelet count periodically during therapy. Neutropenia and thrombocytopenia may rarely occur

» May cause serum bilirubin, hepatic enzymes, total cholesterol, nonprotein nitrogen (NPN), and uric acid concentrations

Potential Nursing Diagnoses

• Risk for injury (Indications)(Side Effects)

Implementation

• Discontinue clopidogrel 5–7 days before planned surgical procedures

• PO: Administer once daily without regard to food

Patient/Family Teaching

• Instruct patient to take medication exactly as directed. Take missed doses as soon as possible unless almost time for next dose; do not double doses

• Advise patient to notify health care professional promptly if fever, chills, sore throat, or unusual bleeding or bruising occurs

• Advise patient to notify health care professional of medication regimen prior to treatment or surgery

• Instruct patient to avoid taking OTC medications containing aspirin or NSAIDs without consulting health care professional

Evaluation/Desired Outcomes

Prevention of stroke, MI, and vascular death in patients at risk

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