Post on 14-Apr-2017
Clopidogrel (Plavix®)Carmen G. Rolf
Lamar UniversityFall 2015
Clopidogrel Antiplatelet Inhibits ADP Prevents
Aggregation Activation
Metabolized in liver Quick acting No antidote Risk: bleeding
Acute Coronary Syndromes First line of defense
after previous MI Treats stable and
unstable angina Helps prevent new MI Can be combined with
aspirin Use with stents
http://humanbodydisease.com/ischemic-heart-disease-intro-795.html
Intended Drug Response Irreversibly binds to
P2Y12 receptors on platelet surfaces
Prevents ADP from binding to receptors
Platelet inactive for life-span (7-10 days)
Prevents clot formationThienopyridines block ADP receptors. Source:Harvey, R; Champe, P “Lippincott illustrated reviews: Pharmacology”, 4th edition. LWW: 2009.
Potential Interactions Hundreds of drugs Proton Pump Inhibitors
Prilosec®, Nexium®, pantoprazole (Protonix®) Warfarin (Coumadin®) NSAIDs SSRIs
Prozac® SNRIs
Adverse Reactions
Bleeding is greatest risk
Increased risk when combined with aspirin
Side Effects/Patient reports Headache GI upset Myalgias Skin problems Confusion
Pharmacokinetics Easily absorbed from
intestine 50% available 6 hr half-life Metabolized in liver
2 step process 85% inactive Uses P450 enzymes
CYP2C19
Results in 2 hours Steady state within 1 week 40 – 60 % platelet
inhibition in normal metabolizers
Ultra rapid to poor metabolizers
Stop at least 5 days before invasive procedures
Drug Binding Issues Any drugs that use the CYP2C19 enzyme for
metabolism Most important: Proton pump inhibitors
Increased risk of clots Omeprazole and esomeprazole worst Pantoprazole better
Improving Communication All insurance companies
involved in oversight with pharmacists
Educate insurance companies on the benefit to risk ratio of clopidogrel versus warfarin
Encourage all providers to communicate with each other
Refine electronic medical records to either alert or allow all providers access to medication changes
Encourage patients to report all medications and side effects to all providers
Home Health Care Report new medications
found in home to all providers
Educate patient Need for med Possible side effects Update/report med list
Educate insurance companies
References Allerman, A.A. & Goldfarb, E.B. (2013). Anticoagulation disturbances. In V.P. Arcangelo & A.M.
Peterson (Eds.). Pharmacotherapeutics for advanced practice (3rd ed.) (pp. 764-803). Philadelphia, PA: Lippincott, Williams, & Wilkins.
Brashers, V.L. (2014). Alterations in cardiovascular function. In McCance, K.L., Huether, S.E., Brashers, V.L., & Rote, N.S. (Eds.). Pathophysiology: the biologic basis for disease in adults and children (7th ed.), pp. 1129-1193. St. Louis, MO: Elsevier.
Reese, A.M. & Peterson, A.M. (2013). Chronic stable angina. In V.P. Arcangelo & A.M. Peterson (Eds.). Pharmacotherapeutics for advanced practice. (3rd ed.) (pp. 263-277). Philadelphia, PA: Lippincott, Williams, & Wilkins.
Rote, N.S., & McNance, K.L. (2014). Structure and function of the hematologic system. In McCance, K.L., Huether, S.E., Brashers, V.L., & Rote, N.S. (Eds.). Pathophysiology: the biologic basis for disease in adults and children (7th ed.), pp. 945-981. St. Louis, MO: Elsevier.
The Rx List. (2015). Plavix (clopidogrel bisulfate) tablets. Retrieved from, http://www.rxlist.com/plavix-drug.htm
Wang, Z.Y., Chen, M., Zhu, L.L., Zeng, S., Xiang, M.X., & Zhou, Q. (2015). Pharmacokinetic drug interactions with clopidogrel: updated review and risk management in combination therapy. Theraputics and Clinical Risk Management, 11, pp.449-467. Doi: http://dx.doi.org/10.2147/TCRM.S80437