Clopidogrel bisulfate is an anti-platelet drug, which prevents platelets from clumping together as a part of a blood clot. It’s chemical structure and in the way of interaction is identical to ticlopidine (Ticlid). In contrast to ticlopidine, clopidogrel bisulfate does not cause serious reductions of white cells in the blood and that is why there is no need to test blood on the level of them during treatment. Patients with a recent history of stroke or heart attack and patients with peripheral vascular disease* have an increased risk of heart attacks and strokes (which usually are caused by blood clots). (*Peripheral vascular disease is the same as atherosclerotic arterial disease or “hardening” of the arteries in which the arteries become narrowed. The symptoms such as claudication or pain in the legs upon walking are usual). Treating by Clopidogrel bisulfate promotes the reduction of the risk of heart attacks and strokes in such patients. The approval of Clopidogrel bisulfate by the FDA was in 1997.

Storage:

Tablets should be kept at room temperature, 15-30°C (59-86°F).

Prescribed for:

Clopidogrel is ordered to prevent strokes and heart attacks in persons who are at high risk. One large study showed that clopidogrel bisulfate was more effective than aspirin in reducing heart attacks. As for side effects clopidogrel bisulfate was similar to aspirin for frequency; however, stomach and intestinal bleeding probably were observed rarely with clopidogrel bisulfate than with aspirin.

Dosing:

Clopidogrel bisulfate usually is taken once daily with or without food.

Drug Interactions:

Treating by clopidogrel together with such drugs as nonsteroidal anti-inflammatory drugs (NSAIDs), for example, ibuprofen (Motrin; Advil; Nuprin), naproxen (Naprosyn, Aleve), diclofenac (Voltaren), etodolac (Lodine), nabumetone (Relafen), fenoprofen (Nalfon), flurbiprofen (Ansaid), indomethacin (Indocin), ketoprofen (Orudis; Oruvail), oxaprozin (), piroxicam (Feldene), sulindac (Clinoril), tolmetin (Tolectin), and mefenamic acid (Ponstel) may growth the danger of stomach and intestinal bleeding. If the concentration of clopidogrel in the blood is high, it prevents the activity of the enzyme which metabolizes (eliminates) warfarin (Coumadin), a “blood thinner”. This could be a cause of an increase in levels of warfarin and growth the risk of bleeding because of over-thinning of the blood. There is no information if interaction in humans between warfarin and clopidogrel is dangerouse or not. Nonetheless, because of warfarin’s quality to increase the risk of bleeding, blood tests to measure the degree when blood can’t coagulate well or becomes thin (prothrombin time; INR) may be ordered to evaluate the degree of blood-thinning in case when both warfarin and clopidogrel are used during the treatment. The same enzyme also answers for the metabolism of phenytoin (Dilantin), tamoxifen (Nolvadex), tolbutamide (Orinase), torsemide (Demadex), and fluvastatin (Lescol). Though it’s unlikely that important interactions between clopidogrel and these drugs can occur, it is better to monitor interactions carefully.

Pregnancy:

There are no information if clopidogrel in harmful for pregnant women. Therefore, if the doctor determines it is needed, it can be used in pregnancy.

Nursing Mothers:

On the basis of studies in rats it was found out that clopidogrel appears in breast milk; however, it is no information whether it also appears in human breast milk. So when prescribing clopidogrel to nursing mothers the doctor should compare the potential benefits to possible risks.

Side Effects:

The tolerability of clopidogrel and aspirin is alike. Diarrhea, rash, or itching takes place in nearly 1 in 20 persons treating by clopidogrel. Abdominal pain also occurs in about 1 in 20 persons, but it is rarely than with aspirin. Ticlopidine (Ticlid) is an antiplatelet medicine quite similar to clopidogrel. It’s influence leads to a severe reduction in white blood cell count in between 0.8% and 1% of persons. As for clopidogrel the danger of appearence of this side effect with clopidogrel is much less than with ticlopidine but twice that of aspirin and averages about 0.04%. The condition of thrombotic thrombocytopenic purpura (TTP) rarely occurs when treating by clopidogrel. It happens in one out of every 250,000 people. When in such condition the blood clots form throughout the body. Blood platelets, which take part in clotting, are consumed, and it can result to bleeding because of absence of normally blood clotting. To observe the situation, ticlodipine (Ticlid), the related drug, become the reason for TTP 17-50 times more frequently than clopidogrel.

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