Plavix (Clopidogrel Bisulfate) 75mg tablets

Indications for PLAVIX:

To reduce the rate of MI and stroke in patients with: non-ST-segment elevation acute coronary syndrome (unstable angina/non-ST-elevation MI) or acute ST-elevation MI; history of recent MI, recent stroke, or established peripheral arterial disease; see full labeling.

Adult:

Acute coronary syndrome (give with aspirin): initially give one 300mg loading dose, then continue at 75mg once daily. Recent MI, recent stroke, or established peripheral arterial disease: 75mg once daily without a loading dose.

Children:

Not established.

Contraindications:

Active pathologic bleeding (eg, peptic ulcer, intracranial hemorrhage).

Boxed Warning:

Diminished antiplatelet effect in patients with two loss-of-function alleles of the CYP2C19 gene.

Warnings/Precautions:

CYP2C19 poor metabolizers: diminished effectiveness in those who are homozygous for nonfunctional alleles of the CYP2C19 gene. Perform testing for the CYP2C19 genotype before starting therapy; consider alternative treatment if identified. Increased risk of bleeding. Premature discontinuation increases risk of cardiovascular events; if temporarily discontinued (eg, to treat bleeding or surgery; if possible, interrupt therapy for 5 days before such surgery); restart as soon as possible. Pregnancy. Labor & delivery. Nursing mothers.

Pharmacologic Class:

P2Y₁₂ platelet inhibitor (thienopyridine).

Interactions:

Avoid concomitant CYP2C19 inhibitors (eg, omeprazole, esomeprazole). Antagonized by opioid agonists (eg, morphine, others); consider using IV anti-platelet agent instead. Caution with concomitant other drugs that increase risk of bleeding (eg, NSAIDs, warfarin, SSRI, SNRI). Avoid concomitant repaglinide; if unavoidable, initiate repaglinide at 0.5mg before each meal; max 4mg/day; monitor glucose frequently.

Adverse Reactions:

Bleeding (may be fatal), epistaxis, hematuria, bruising, ulcers, rash; hypersensitivity reactions, thrombotic thrombocytopenic purpura