clopidogrel
(cloe pid' oh grel)
Plavix
Pregnancy Category B
Drug classes
Adenosine diphosphate (ADP) receptor antagonist
Antiplatelet
Therapeutic actions
Inhibits platelet aggregation by blocking ADP receptors on platelets, preventing clumping of platelets.
Indications
· Treatment of patients at risk for ischemic events—history of MI, ischemic stroke, peripheral artery disease
· Treatment of patients with acute coronary syndrome
Contraindications and cautions
· Contraindicated with allergy to clopidogrel, active pathological bleeding such as peptic ulcer or intracranial hemorrhage, lactation.
· Use cautiously with bleeding disorders, recent surgery, hepatic impairment, pregnancy.
Available forms
Tablets—75 mg
Dosages
ADULTS
Recent MI, stroke, or established peripheral arterial disease: 75 mg PO daily.
Acute coronary syndrome: 300 mg PO loading dose, then 75 mg/day PO with aspirin, given at a dose from 75–325 mg once daily.
Pharmacokinetics
Route | Onset | Peak | Duration |
Oral | Varies | 1 hr | 2 hr |
Metabolism: Hepatic; T1/2: 8 hr
Distribution: Crosses placenta; enters breast milk
Excretion: Bile, feces, urine
Adverse effects
· CNS: Headache, dizziness, weakness, syncope, flushing
· CV: Hypertension, edema
· Dermatologic: Rash, pruritus
· GI: Nausea, GI distress, constipation, diarrhea, GI bleed
· Other: Increased bleeding risk
Interactions
Drug-drug
· Increased risk of GI bleeding with NSAIDs, monitor patient carefully
· Increased bleeding with warfarin; monitor carefully
Nursing considerations
Assessment
· History: Allergy to clopidogrel, pregnancy, lactation, bleeding disorders, recent surgery, hepatic impairment, peptic ulcer
· Physical: Skin color, T, lesions; orientation, reflexes, affect; P, BP, orthostatic BP, baseline ECG, peripheral perfusion; R, adventitious sounds
Interventions
· Provide small, frequent meals if GI upset occurs (not as common as with aspirin).
· Provide comfort measures and arrange for analgesics if headache occurs.
Teaching points
· Take daily as prescribed. May be taken with meals.
· You may experience these side effects: Dizziness, light-headedness (this may pass as you adjust to the drug); headache (lie down in a cool environment and rest; over-the-counter preparations may help); nausea, gastric distress (eat frequent small meals); prolonged bleeding (alert dentists and health care providers of this drug use).
· Report skin rash, chest pain, fainting, severe headache, abnormal bleeding.
Adverse effects in Italic are most common; those in Bold are life-threatening.
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