Known brand names include Plavix.
An oral antiplatelet drug that keeps platelets from clumping. It lowers the risk of heart attack and stroke after acute coronary syndrome, a recent heart attack or stroke, or with peripheral artery disease.
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Oral clopidogrel is not on the ISMP acute care list. Its antithrombotic category names anticoagulants, factor Xa and direct thrombin inhibitors, IV glycoprotein IIb/IIIa inhibitors, and thrombolytics.
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The label does not describe a narrow therapeutic index or direct dosing by measured blood levels of the drug.
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Reduced effect in CYP2C19 poor metabolizers. Clopidogrel works only after CYP2C19 converts it to its active form. Patients with two loss-of-function CYP2C19 alleles make less active metabolite and get less platelet inhibition. Genetic tests can identify them; consider another P2Y12 inhibitor for these patients.
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No specific reversal agent; platelet inhibition is irreversible and lasts the life of the platelet. Platelet transfusion may restore clotting, but it may work less well within 4 hours of a loading dose or 2 hours of a maintenance dose.
Doses come from the FDA label. Study tool, not for clinical decisions.
No dose change is labeled. Experience in moderate and severe renal impairment is limited, and platelet inhibition was lower in these patients.
A prodrug. Liver CYP enzymes, mainly CYP2C19, convert it to an active metabolite that binds the platelet P2Y12 ADP receptor irreversibly. This blocks ADP-driven activation of the GP IIb/IIIa complex, so platelets cannot aggregate for the rest of their lifespan (about 7 to 10 days). Steady-state inhibition is reached between day 3 and day 7 without a loading dose.