Clopidogrel
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Trade Name
Plavix (primary brand name); generic clopidogrel bisulfate
Classification
Antiplatelet agent; P2Y12 ADP receptor inhibitor
Dosage/Route
- * Dosage: Tablets: 75 mg, 300 mg
- * Route: Oral (PO)
Usual Dosage
- * Adults:
- – Acute Coronary Syndrome (ACS)/Post-Stent: 300 mg PO loading dose, then 75 mg PO daily (with aspirin)
- – Recent MI/Stroke/Peripheral Artery Disease: 75 mg PO daily (no loading dose)
- * Duration: Varies (e.g., 1 year post-stent; lifelong for some indications)
- * No adjustment for renal/hepatic impairment; caution in poor CYP2C19 metabolizers
Mechanism of Action
Irreversibly inhibits P2Y12 ADP receptors on platelet surfaces, preventing ADP-mediated platelet activation and aggregation. Reduces risk of thrombus formation in coronary, cerebral, or peripheral arteries
Side Effects & Adverse Effects
- * Side Effects: Bruising, diarrhea, rash, pruritus
- * Adverse Effects:
- – Bleeding (boxed warning; major GI, intracranial hemorrhage)
- – Thrombotic thrombocytopenic purpura (TTP) (rare; fever, purpura)
- – Hypersensitivity (rare; angioedema)
- – Premature discontinuation increases stent thrombosis risk (boxed warning)
Nursing Management (Implications & Teachings)
- * Implications:
- – Monitor for bleeding (e.g., black stools, hematuria, epistaxis)
- – Assess CBC (thrombocytopenia, TTP signs); neuro status (stroke/ICH risk)
- – Stop 5-7 days before elective surgery (bleeding risk)
- – Check for CYP2C19 status (poor metabolizers may need alternative like prasugrel)
- * Teachings:
- – Take daily, with/without food; don’t stop without MD consult
- – Report unusual bleeding, bruising, or purple spots
- – Inform providers before dental/surgical procedures
- – Avoid NSAIDs/OTC drugs unless approved (bleeding risk)
Indication for This Patient
- * Acute coronary syndrome (STEMI, NSTEMI, unstable angina)
- * Post-stenting (prevent stent thrombosis)
- * Recent myocardial infarction, stroke, or peripheral artery disease (reduce thrombotic events)
Time
- * Timing: Once daily (consistent time)
- * Onset: Platelet inhibition in 2-5 hours (loading dose); steady-state 3-7 days (75 mg)
- * Peak: 1-2 hours
- * Duration: Platelet effect lasts ~7-10 days (lifespan of platelet)
