Clopidogrel
Brand names: Plavix
Class: 🩸 Anticoagulants & Antiplatelets
What examiners watch for is whether you can pair clopidogrel with the right arterial-disease scenario and avoid the CYP2C19 trap. Clopidogrel is a P2Y12 antagonist that irreversibly blocks platelet activation. It is given with aspirin for dual antiplatelet therapy after coronary stenting, after ACS, in PAD, and as monotherapy for secondary stroke prevention when aspirin is intolerable. It is a prodrug activated by CYP2C19 — so omeprazole and esomeprazole reduce its effect; pantoprazole has the cleanest interaction profile and is the preferred PPI in stented patients. Stop 5–7 days before non-urgent surgery if bleeding risk dominates. Bleeding is the major adverse effect, similar to aspirin.
✅ Indications
Post-stent DAPT (+ aspirin), post-ACS, secondary stroke prevention, PAD.
⚙️ Mechanism of Action
P2Y12 receptor antagonist — irreversible platelet inhibition.
📏 Dosing
Load 300–600 mg, then 75 mg PO daily.
🚫 Contraindications
Active bleeding.
⚠️ Adverse Effects
Bleeding, TTP (rare), ↓ effect with omeprazole.
🔬 Monitoring
CBC, platelets if TTP suspected.
💎 Board Pearls
- 🧬 PRODRUG activated by CYP2C19 — 30% of Asian, 15% Caucasian population are POOR METABOLIZERS → reduced effect.
- 🚫 Omeprazole + clopidogrel → reduced antiplatelet effect (use pantoprazole instead).
- 🩸 DAPT duration: 6–12 months post-stent, then aspirin alone long-term.
Practice Questions
A 58-year-old woman with a drug-eluting stent placed 2 months ago is on clopidogrel 75 mg daily and aspirin 81 mg daily. Chart review reveals she was also started on omeprazole 20 mg daily for reflux. Which of the following is the MOST appropriate management step?
Related Drugs in This Class
- Warfarin — Coumadin, Jantoven
- Apixaban — Eliquis
- Rivaroxaban — Xarelto
- Aspirin — Bayer, Ecotrin
Sources
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