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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 or stroke: 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 75 min 3–4 hr

Metabolism: Hepatic; T1/2: 8 hr


Distribution: Crosses placenta; enters breast milk
Excretion: Feces, bile, and 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
• Potential increased risk of GI bleeding with NSAIDs, monitor patient carefully
• Potential 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, temperature, 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.
• These side effects may occur: 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 small, frequent
meals); prolonged bleeding (alert doctors, dentists 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.