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Plavix
clopidogrel
Black Box Warnings .
Diminished Antiplatelet Effect in CYP2C19 Poor Metabolizers
clopidogrel antiplatelet effect is dependent on conversion to active metabolite by CYP450 enzymes, principally CYP2C19; in pts homozygous for nonfunctional alleles of CYP2C19 gene (CYP2C19 poor metabolizers), clopidogrel forms less active metabolite and has reduced anti-platelet activity at recommended doses; CYP2C19 genotype tests are avail. to identify CYP2C19 poor metabolizers; consider using other platelet P2Y12 inhibitor tx in CYP2C19 poor metabolizers
Adult Dosing .
Dosage forms: TAB: 75 mg, 300 mg
acute coronary syndrome
- [75 mg PO qd]
- Start: 300-600 mg PO x1; Info: give w/ aspirin; may use w/ heparin acutely; depending on bleeding risk, consider holding tx 5 days before surgery or invasive procedure; resume tx w/in 24h postop
thrombotic event risk reduction
- [75 mg PO qd]
- Info: for pts w/ recent MI, recent stroke, or symptomatic peripheral arterial dz; depending on bleeding risk, consider holding tx 5 days before surgery or invasive procedure; resume tx w/in 24h postop
renal dosing
- [see below]
- CrCl >60: no adjustment; CrCl <60: not defined, caution advised
- HD/PD: not defined
hepatic dosing
- [no adjustment]
Peds Dosing .
- Dosage forms: TAB: 75 mg, 300 mg
TIA/thromboembolic stroke prevention (off-label)
- [<2 yo]
- Dose: 0.2 mg/kg/dose PO qd; Max: 75 mg/day; Info: refer to ACCP guidelines or institution protocols for details on appropriate use
- [2 yo and older]
- Dose: 1 mg/kg/dose PO qd; Max: 75 mg/day; Info: refer to ACCP guidelines or institution protocols for details on appropriate use
renal dosing
- [not defined]
- renal impairment: consider adult renal dosing for guidance
- HD/PD: not defined
hepatic dosing
- [not defined]
- hepatic impairment: consider adult hepatic dosing for guidance