Clopidogrel and Aspirin

Anticoagulant/Antiplatelet · Antiplatelet/Salicylate

Indications

Prevention of atherothrombotic events in patients suffering from myocardial infarction (from a few days until less than 35 days), ischaemic stroke (from day 7 until less than 6 months) or established peripheral artery disease. In combination with aspirin in non-ST segment elevation acute coronary syndrome (unstable angina or non-Q-Wave MI.

Dosage

Adults: 1 tab daily. Children: Not recommended.

Adverse Effects

Clopidogrel: Bleeding episodes, GI upset, haematoma, skin reactions. Nervous system, hepatic, biliary or haematological disorders. Rarely, thrombotic thrombocytopenic purpura. Stevens-Johnson syndrome. Aspirin: Bronchospasm, GI upset, allergic reactions, GI and other haemorrhage. Tinnitus, vertigo, confusion, increased bleeding.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Contraindicated in pregnancy. Lactation: Contraindicated or not recommended. Contraindications: Clopidogrel: Severe hepatic impairment, active bleeding such as peptic ulcer or intracranial haemorrhage. Do not initiate therapy within first few days after MI. PTCA (stenting), CABG and acute ischaemic stroke of less than 7 days. Aspirin: Previous or active peptic ulceration, haemophilia and other bleeding disorders. Severe renal or hepatic impairment. Children under 16 years unless specifically indicated (e.g. for Kawasaki's disease). Precautions: Clopidogrel: Renal impairment, moderate hepatic impairment. Surgery. Risk of bleeding and blood dyscrasias; perform blood counts promptly if suspected and when used with other drugs or conditions that affect bleeding. Warn patients to report unusual bleeding. Risk of acquired haemophilia; discontinue if confirmed. Aspirin:…

Interactions

Clopidogrel: Anticoagulants, glycoprotein IIb/IIIa inhibitors, thrombolytics, NSAIDs, SSRIs, pentoxifylline, PPIs and other moderate or strong CYP2C19 inhibitors. CYP2C8 substrates (e.g., repaglinide). Aspirin: Oral anticoagulants, heparin, antiplatelet agents, fibrinolytics, NSAIDs, uricosuric agents, methotrexate, SSRls, venlafaxine, corticosteroids, acetazolamide, tacrolimus, ciclosporin, antihypertensives.

Advice to Patient

Take with or without meals.

Pharmacokinetics

CLOPIDOGREL: Onset of action: Inhibition of platelet aggregation (IPA): Dose-dependant: 300-600 mg loading dose: Detected within 2 hrs. 50-100 mg/day: Detected by the second day of treatment. Peak effect: Time to maximal IPA: Dose-dependant: Degree of IPA based on adenosine diphosphate (ADP) conc used during light aggregometry. 300-600 mg loading dose: ADP 5 micromole/L: 20%-30% IPA at 6 hrs post administration. ADP 20 micromole/L: 30%-37% IPA at 6 hrs post administration. 50-100 mg/day: ADP 5 micromole/L: 50%-60% IPA at 5-7 days. Duration of action: Approx. 5 days after discontinuation. Absorption: Rapid, well absorbed. Metabolism: Extensively hepatic. Half-life elimination: Parent drug: Approx. 6 hrs. Time to peak, serum: Approx. 0.75 hrs. Excretion: Urine (50%). Faeces (46%). ASPIRIN: Onset: Immediate release: Platelet inhibition: Within 1 hr (nonenteric-coated). Onset of…

Compiled by Healify Pharmacy from published drug references. How we compile it →

Always consult a pharmacist or doctor.