Clopidogrel

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

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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

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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 Oral

Onset Varies

Peak 75 min

Duration 3–4 hr

Metabolism: Hepatic; T1/2: 8 hr Distribution: Crosses placenta; enters breast milk Excretion: Feces, bile, and urine Adverse effects

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CNS: Headache, dizziness, weakness, syncope, flushing CV: Hypertension, edema Dermatologic: Rash, pruritus GI: Nausea, GI distress, constipation, diarrhea, GI bleed

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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

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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

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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

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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-thecounter 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.