Plavix (Clopidogrel) Uses, Dosage, Side effects, Interactions, & Warnings

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Plavix (Generic Name Clopidogrel) is a member of a group of drugs known as platelet inhibitors. Other drugs that has a similar mechanism include Prasugrel (Effient) and Ticagrelor (Brilinta).

Platelets are blood cells which help blood clot normally. Clopidogrel prevents platelets sticking together. They are prevented from forming blood clots.

Clopidogrel oral tablets are available in both generic and brand-name versions. Plavix is the brand name.

Clopidogrel = Plavix

What is Plavix (Clopidogrel)?

Clopidogrel oral tablets is a prescription drug. It is also available under the brand name Plavix. You can also get it as a generic drug. Generic drugs are usually cheaper than the brand-name versions. They may not be in the same strengths or forms as brand-name drugs in some cases.

What is plavix (Clopidogrel) used for?

Clopidogrel is a medication that can prevent blood clotting in the following situations:

  • heart attack (Also called myocardial infarction),
  • stroke or CVA (cerebrovascular accident),
  • peripheral arterial disease (as a result of poor circulation)
  • Angina.

You may use this drug as part of a combination treatment. This means that you might need to take it along with other medications. If you need to take this drug along with another drug, your doctor will determine.

Plavix (Clopidogrel) Side effects:

Side effects of plavix can be mild to severe with clopidogrel oral tablets. Here are some side effects of Clopidogrel.

Common side effects of Plavix:

Clopidogrel can cause side effects more frequently than you might think.

  • Bleeding
  • itchy skin

Bleeding is a result of the drug’s mechanism of action. Since it inhibits the platelets to become sticky, bleeding can occur. Itchy skin is a result of an allergic reaction to the drug and may disappear in a few days, or even weeks. Talk to your pharmacist if it persists or becomes more severe.

Beware! Serious Bleeding can occur

Serious side effects of Plavix (Clopidogrel):

If you experience serious side effects or if your symptoms are severe or life-threatening, call your doctor immediately.

Symptoms that can indicate a serious event may include:

  • Serious, life-threatening bleeding.
    • Unexplained bleeding, or bleeding that continues for a long period
    • You may have blood in your urine (pink or red urine, or brown urine).
    • Red or black stools with tar-like appearance
    • Unexplained bruises, or bruises that grow larger
    • Coughing up blood or blood clots
    • Vomit or blood that looks like coffee grounds can be vomited.

Thrombotic Thrombocytopenic Purpura (TTP):

TTP is a blood-clotting condition. Clopidogrel can cause this condition, even if it is only for a few weeks. TTP is when blood clots form anywhere in the body. You should seek immediate medical attention if you have any of these symptoms.

  • Purplish spots (purpuras) on your skin and in your mouth (mucous membrane), are signs of bleeding under your skin.
  • Jaundice is a yellowing or sagging of your skin and eyes.
  • Tiredness or weakness
  • pale-looking skin
  • Fever
  • Rapid heart rate, or shortness in breath
  • trouble speaking or understanding language (aphasia)
  • confusion
  • coma
  • Stroke
  • seizure
  • Low urine volume, urine with blood or pink in it
  • stomach pain
  • nausea, vomiting, or diarrhea
  • vision loss
Pentad of TTP (thrombotic thrombocytopenic purpura

Plavix (Clopidogrel) interaction with other medications:

Clopidogrel is broken down by your liver. There are genetic differences between people and how their liver enzymes work. This enzyme is called cytochrome p450 2C19 (CYP2C19). This could cause your liver to process the drug slower, making it less effective. To determine if you have the genetic difference, your doctor might test you. Your doctor may prescribe alternative treatments or drugs to clopidogrel if you have it.

Plavix drug interactions are primarily due to the enzyme cytochrome P450 2C19. Medicines that are metabolized by this enzyme can either increase or decrease its levels. These are called enzyme inducers and enzyme inhibitors.

Clopidogrel oral tablets can interact with other medications. Different interactions can cause different effects. One example is that some may interfere with the effectiveness of a drug, while others could cause more side effects.

Here is a list that includes medications that may interact with Clopidogrel. This list may not include all drugs that can interact with Clopidogrel.

Diabetes drugs interactions with Plavix:

  • Clopidogrel can enhance the effect of repaglinide. It should be avoided in most cases. Combining these drugs can increase the body’s repaglinide levels, which could lead to low blood sugar. Your doctor will monitor your dose of repaglinide if you have to take both drugs.

Stomach acid drugs (proton pumps inhibitors):

Clopidogrel should not be taken with medications used to treat stomach acids. Clopidogrel may be less effective if they are combined. These drugs include:

  • Omeprazole
  • esomeprazole

Read: Can You Take Plavix and Omeprazole Together?

Nonsteroidal anti-inflammatory drug (NSAIDs):

Clopidogrel taken with NSAIDs can increase the risk of bleeding in your stomach or intestines. These drugs include:

  • Aspirin
  • Ibuprofen
  • naproxen
  • Blood thinners

Aspirin and clopidogrel should be used if you have acute coronary syndrome. However, if you have recently suffered a stroke, these drugs should not be taken together. This can increase the chance of major bleeding.

Both clopidogrel and warfarin work in different ways to thin blood. Combining them can increase your risk of bleeding. It should also be taken with extreme caution in combination with the novel blood thinners such as Eliquis (Apixaban) and Xarelto (Rivaroxaban).

Read: Eliquis Vs Plavix (Comparison of Apixaban and Clopidogrel)

Plavix interactions with drugs that treat depression:

Certain antidepressants when taken in combination with clopidogrel can increase bleeding risk. These drugs include:

  • Selective serotonin reuptake inhibitors (SSRIs).
  • serotonin-norepinephrine reuptake inhibitors (SNRIs)

Plavix Drug Interactions with Opioids:

Combining opioid medication and clopidogrel may delay or reduce the absorption of the drug. This can make it less effective. Your doctor may recommend additional medication to prevent blood clots if you have to take both of these drugs.

Some examples of opioids are:

  • codeine
  • Hydrocodone
  • Fentanyl
  • Morphine

How do you take Plavix (Clopidogrel)?

Your doctor will prescribe the right dose of Clopidogrel depending on what condition you are trying to treat.

Your doctor will usually start you with a low dose and then adjust it as needed to make sure you are getting the right dosage. The doctor will eventually prescribe the lowest dose that delivers the desired effect.

Below are recommended dosages. Be sure to follow the doctor’s instructions. Your doctor will recommend the right dosage for you.

Forms and strengths

  • Generic: Clopidogrel
    • Oral tablet Strengths: 75 mg and 300 mg
  • Brand: Plavix 
    • Oral tablet Strengths: 75 mg and 300 mg

Plavix Dosage in acute coronary syndrome:

Adult dosage for those 18 and over:

  • The usual starting dose is 300 mg taken once. The delay in the effects of starting treatment without a loading dose is several days.
  • Maintenance dose: 75 mg once daily.

Children dosage (ages 0-17 years)

  • This drug was not studied in children, and should not be administered to anyone younger than 18.

Plavix dosage in recent heart attack, stroke, or peripheral arterial disease:

  • Adult dosage for those 18 and over
    • 75 mg once daily is the usual dosage.
  • Children dosage (age 0-17 years)
    • This drug was not studied in children, and should not be administered to anyone younger than 18.

Plavix Warnings and Precautions:

FDA Warning: Liver Function Warning

Black Box Warning: This drug is a Schedule II drug. This warning is the most severe as per the Food and Drug Administration. Doctors and patients are alerted to potential dangers by a black box warning.

Your liver is responsible for breaking down Clopidogrel. There are genetic differences between people and how cytochrome p450 2C19 (CYP2C19) works. This could affect how the drug is broken down and cause it to not work as well. To determine if you have the genetic difference, your doctor might test you. Your doctor may prescribe alternative treatments or drugs to clopidogrel if you have it.

Warning about serious bleeding

Clopidogrel can cause severe and sometimes fatal bleeding. Clopidogrel can cause bleeding problems, including nosebleeds and bruises. It may also make it more difficult to stop bleeding. Any serious bleeding should be reported to your doctor.

  • Excessive, persistent, or unexplained bleeding
  • You may have blood in your stool or urine

Notification for surgery or procedure

Clopidogrel should be disclosed to your dentists and doctors before you have any procedure. To prevent complications, you may have to stop taking the drug temporarily. To avoid bleeding, your doctor will tell you when to stop taking the medication and when it is okay to start it again.

Allergy warning

Clopidogrel may cause severe allergic reactions. Some symptoms include:

  • Trouble breathing
  • Swelling of the lips, throat, tongue, and cheeks

If you have ever experienced an allergic reaction, don’t take the drug again. If you are allergic to thienopyridines, such as clopidogrel and ticlopidine, this drug should be avoided. It is possible to become fatal if you take it again after having an allergic reaction.

Plavix Interaction with Alcohol:

While you’re taking alcohol, it can increase your chance of bleeding.

People with certain conditions should be aware

  • Clopidogrel should not be taken by people who have active bleeding. Clopidogrel increases your chance of bleeding and prevents you from clotting.
  • Clopidogrel should be avoided by people who have an allergy to thienopyridines.
  • If you have had a stroke, this drug should not be taken with aspirin. You could get serious bleeding.

Plavix use in pregnancy:

There has been no evidence that clopidogrel can cause miscarriage or birth defects in studies done on pregnant women who took it. These risks have also not been found in studies of Clopidogrel in pregnant animals.

If a stroke or heart attack occurs during pregnancy, it can pose risks for the mother and her baby. Clopidogrel may be beneficial in preventing these events.

If you are pregnant, or intend to become pregnant, tell your doctor. Clopidogrel should not be used during pregnancy unless the potential benefits outweigh the risk.

Plavix use by breastfeeding mothers:

Clopidogrel can pass into breastmilk. Clopidogrel can cause severe side effects in breastfed children if it is. Your doctor and you may have to decide whether or not to breastfeed.

Children under 18 years old:

Clopidogrel’s safety and effectiveness have not been proven safe.

Follow the instructions as advised by your physician:

Long-term treatment is possible with Clopidogrel oral tablets. If you don’t take it as directed, there are serious side effects.

Your risk of a stroke or heart attack increases if you stop taking the drug. These conditions could prove fatal.

Clopidogrel should be stopped temporarily by your doctor. You can then resume taking it as soon as you are told to. You may have a higher chance of stroke, serious heart problems, and blood clots in your legs and lungs if you stop taking this drug.

You may have to miss doses, or not take your medication on time. Your medication could stop working or not work at all. To make this drug work, you must have a certain amount in your body at all time.

You could get dangerous levels of the drug if you take too much. An overdose can cause bleeding.

If you think you have taken too many of these medications, you should consult your doctor. If your symptoms are severe, you should call for help immediately or visit the nearest emergency room.

What to do if you forget a dose? 

Skip the missed dose if it is near time for your next dose. Only take one dose at a time. Unless your doctor has instructed you otherwise, do not take more than one dose of clopidogrel.

Plavix: Important points to consider:

These are the things to consider if you receive a prescription for clopidogrel oral tablets from your doctor.

General

  • Do not chop or crush the tablet.

Storage

  • Clopidogrel should be kept at room temperature between 77 and 86 degrees Fahrenheit (25 to 35C). You can store it for a brief time at temperatures between 59°F and 86°F (15°C and 30°C).
  • Do not store this medication in moist or damp areas like bathrooms.

Travel:

  • Take your medication with you when you travel
  • Always keep your medication close by. Never check your medication into a bag. It should be kept in your carry-on bag
  • Don’t be alarmed by airport Xray machines. They won’t damage your medication.
  • Staff at airports may ask for the prescription label of your medication. Always bring the original prescription-labeled container.
  • This medication should not be left in your car’s glove box or in your car’s trunk. Avoid doing this in extreme heat or cold.

Self-management

  • Your doctor will explain to you and your family the signs of stroke, heart attack, or blood clots in your legs or lungs. These symptoms should be reported immediately to your doctor or 911.

Clinical monitoring when using Plavix:

Your doctor may order a genetic test to determine your CYP2C19 gene before you start treatment with clopidogrel. Your doctor will use this genetic test to determine if you should be taking clopidogrel. Some genotypes slow how clopidogrel is broken down. This drug might not work for you if you have this type of genotype.

Your doctor will perform the following tests to ensure that your medication is safe and effective.

  • Complete blood count (CBC).
  • Signs of bleeding

Availability of Plavix:

Clopidogrel generic is available in most pharmacies. Plavix, however, is not always available at all pharmacies. When filling your prescription for Plavix from your doctor, make sure you call ahead to confirm that your pharmacy stocks it.

You may also be able to use other medications to treat your condition. You may find some more suitable than others. Discuss other drugs with your doctor that may be a good option for you.