Clopidogrel
Mechanism of Action:
The active metabolite selectively inhibits the binding of ADP to its platelet receptor and the subsequent activation of GPIIb/IIIa Complex, inhibiting platelet aggregation.
Indications:
- Acute coronary syndrome
- Established peripheral arterial disease (PAD)
- Acute ST- elevation MI
- Aspirin intolerance / hypersensitivity
- Graft patency (saphenous vein)
- Prophylaxis of atherosclerotic events in patients with coronary, cerebral or peripheral vascular disease
| Clopidogrel |
| Availability: Tablets: 75 mg, 300 mg |
| Administration/handling: PO • Give without regard to food. • Avoid grapefruit products. |
| Recent MI, Stroke, PAD PO: Adults, elderly: 75 mg once daily |
| Acute Coronary Syndrome (ACS), Unstable Angina/NSTEMI PO: Adults, elderly: Initially, loading dose of 300–600 mg, then 75 mg once daily (in combination with aspirin for up to 12 months, then aspirin indefinitely) |
| ACS (STEMI) Note: Continue for at least 14 days up to 12 mos in absence of bleeding. PO: Adults, elderly 75 yrs or younger: Initially 300-mg loading dose, then 75 mg once daily. Elderly older than 75 yrs: 75 mg once daily. |
| ACS (PCI) PO: ADULTS, ELDERLY: Initially, 600 mg, then 75 mg once daily (in combination with aspirin) for at least 12 months. |
Cautions & Contraindications:
- Active bleeding (e.g., peptic ulcer, intracranial hemorrhage)
- Use with caution in severe renal & hepatic impairment & trauma
- Concurrent use with anticoagulants
Side- Effects:
- Skin Disorders
- Bleeding
- Upper respiratory tract infections
- Chest pain
- Flu like symptoms
- Headache
- Dizziness
- Arthralgia
- Agranulocytosis, aplastic anemia/pancytopenia occur rarely
- GI disturbances
Metabolism and Half-life:
Rapidly absorbed. Protein binding: 98%. Metabolized in liver. Eliminated equally in the urine and feces. Half-life: 8 hrs.
Drug Interactions:
Caution is given in combination with other antiplatelet, anticoagulant or fibrinolytics due to risk of bleeding.
Important points:
- Can be given in combination with low – dose aspirin in ACS and acute MI.
- Given as loading dose (300 – 600 mg) at the initiation of treatment.
- Usually stopped 7 days pre- operatively, to reduce the risk of perioperative bleeding.
Nursing Considerations
Baseline assessment:
- Obtain baseline chemistries, platelet count, PFA.
- Perform platelet counts before drug therapy, every 2days during first week of treatment, and weekly thereafter until therapeutic maintenance dose is reached.
- Abrupt discontinuation of drug therapy produces elevated platelet count within 5 days.
Intervention/evaluation:
- Monitor platelet count for evidence of thrombocytopenia.
- Assess Hgb, Hct, for evidence of bleeding.
- serum ALT, AST, bilirubin, BUN, creatinine; signs/symptoms of hepatic insufficiency during therapy.
Patient /Family Teaching
- It may take longer to stop bleeding during drug therapy.
- Report any unusual bleeding.
- Inform physicians, dentists if clopidogrel is being taken, esp. before surgery is scheduled or before taking any new drug
- Patient should know that he/she may bleed more easily or for a longer time than usual while they are taking clopidogrel. Be careful not to cut or hurt yourself while you are taking clopidogrel.
REFERENCES
- Robert Kizior, Keith Hodgson, Saunders Nursing Drug handbook,1st edition 2024, Elsevier Publications. ISBN-9780443116070
- McGraw Hill- Drug Handbook, Seventh Edition, 2013, McGraw Hill Education Publications,9780071799430.
- April Hazard, Cynthia Sanoski, Davi’s Drug Guide for Nurses -Sixteenth Edition 2019, FA Davis Company Publications,9780803669451.
- Jones and Bartlet, Pharmacology for Nurses, Second Edition, 2020, Jones and Bartlet Learning Publications, ISBN 9781284141986.
- Nursebro.com, Search – Nursebro
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