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This article needs additional citations for verification. Please help improve this article by adding reliable references (ideally, using inline citations). Unsourced material may be challenged and removed. (March 2009)ClopidogrelSystematic (IUPAC) name(+)-(S)-methyl 2-(2-chlorophenyl)-2-(6,7-dihydrothienopyridin-5(4H)-yl)acetateIdentifiersCAS number113665-84-2ATC codeB01AC04PubChem60606DrugBankAPRD00444ChemSpider54632Chemical dataFormulaC16H16ClNO2S Mol. mass321.82 g/molSMILESeMolecules & PubChemPharmacokinetic dataBioavailability>50%Protein binding94–98%MetabolismHepaticHalf life7–8 hours (inactive metabolite)Excretion50% renal46% biliaryTherapeutic considerationsPregnancy cat.B1(AU) B(US)Legal statusPrescription Only (S4)(AU) POM(UK) ℞-only(US)RoutesOralClopidogrel is an oral antiplatelet agent (thienopyridine class) to inhibit blood clots in coronary artery disease, peripheral vascular disease, and cerebrovascular disease. It is marketed by Bristol-Myers Squibb and Sanofi-Aventis under the trade name Plavix, by Sun Pharmaceuticals under the trade name Clopilet and by Ranbaxy Laboratories under the trade name Ceruvin. It works by irreversibly inhibiting a receptor called P2Y12. Adverse effects include hemorrhage.// PharmacologyClopidogrel is a pro-drug whose action may be related to adenosine diphosphate (ADP) receptor on platelet cell membranes. The specific subtype of ADP receptor that clopidogrel irreversibly inhibits is P2Y12 and is important in platelet aggregation and the cross-linking of platelets by fibrin. The blockade of this receptor inhibits platelet aggregation by blocking activation of the glycoprotein IIb/IIIa pathway. The IIb/IIIa complex functions as a receptor mainly for fibrinogen and vitronectin but also for fibronectin and von Willebrand factor. Activation of this receptor complex is the "final common pathway" for platelet aggregation, and is important in platelet aggregation, the cross-linking of platelets by fibrin.Platelet inhibition can be demonstrated two hours after a single dose of oral clopidogrel, but the onset of action is slow, so that a loading-dose of 300-600 mg is usually administered. Clinical use IndicationsClopidogrel is indicated for:Prevention of vascular ischaemic events in patients with symptomatic atherosclerosisAcute coronary syndrome without ST-segment elevation (NSTEMI), along with aspirinST elevation MI (STEMI)It is also used, along with aspirin, for the prevention of thrombosis after placement of intracoronary stent. International guidelines granted the highest grade of recommendation for NSTE-ACS, PCI and stent, for Clopidogrel in addition to Aspirin. Consensus-based therapeutic guidelines recommend also the use of clopidogrel, instead of aspirin, in patients requiring antiplatelet therapy but with a history of gastric ulceration, as inhibition of the synthesis of prostaglandins by aspirin (acetylsalicylic acid) can exacerbate this condition. A recent study has shown that in patients with healed aspirin-induced ulcers, however, patients receiving aspirin plus the proton pump inhibitor esomeprazole had a lower incidence of recurrent ulcer bleeding than patients receiving clopidogrel. Dosage formsClopidogrel is marketed as clopidogrel bisulfate (clopidogrel hydrogen sulfate), most commonly under the trade names Plavix, as 75 mg oral tablets. Pharmacokinetics and metabolismAfter repeated 75-mg oral doses of clopidogrel (base), plasma concentrations of the parent compound, which has no platelet inhibiting effect, are very low and are generally below the quantification limit (0.000258 mg/L) beyond 2 hours after dosing.Clopidogrel is a pro-drug activated in the liver by cytochrome P450 enzymes, including CYP2C19. The active metabolite has an elimination half-life of about 8 hours and acts by forming a disulfide bridge with the platelet ADP receptor. Patients with a variant allele of CYP2C19 are 1.5 to 3.5 times more likely to die or have complications than patients with the high-functioning allele.Following an oral dose of 14C-labeled clopidogrel in humans, approximately 50% was excreted in the urine and approximately 46% in the feces in the 5 days after dosing.Effect of Food: Administration of PLAVIX (clopidogrel bisulfate) with meals did not significantly modify the bioavailability of clopidogrel as assessed by the pharmacokinetics of the main circulating metabolite.Absorption and Distribution: Clopidogrel is rapidly absorbed after oral administration of repeated doses of 75 mg clopidogrel (base), with peak plasma levels (appx. 3 mg/L) of the main circulating metabolite occurring approximately 1 hour after dosing. The pharmacokinetics of the main circulating metabolite are linear (plasma concentrations increased in proportion to dose) in the dose range of 50 to 150 mg of clopidogrel. Absorption is at least 50% based on urinary excretion of clopidogrel-related metabolites. Clopidogrel and the main circulating metabolite bind reversibly in vitro to human plasma proteins (98% and 94%, respectively). The binding is nonsaturable in vitro up to a concentration of 110 μg/mL.Metabolism and Elimination: In vitro and in vivo, clopidogrel undergoes rapid hydrolysis into its carboxylic acid derivative. In plasma and urine, the glucuronide of the carboxylic acid derivative is also observed. Adverse effectsSerious adverse drug reactions associated with clopidogrel therapy include:Severe neutropenia (Incidence: 1/2,000)Thrombotic thrombocytopenic purpura (TTP) (Incidence: 4/1,000,000 patients treated)Hemorrhage - The incidence of hemorrhage may be increased by the co-administration of aspirin.Gastrointestinal Hemorrhage (Incidence: 2.0%)Cerebral Hemorrhage (Incidence: 0.1 to 0.4%)Use of non-steroidal anti-inflammatory drugs is discouraged in those taking clopidogrel due to increased risk of digestive tract hemorrhage Marketing and litigationPlavix is marketed worldwide in nearly 110 countries, with sales of US$5.9 billion in 2005. It had been the 2nd top selling drug in the world for a few years as of 2007 and was still growing by over 20% in 2007.In 2006, generic clopidogrel was briefly marketed by Apotex, a Canadian generic pharmaceutical company before a court order halted further production until resolution of a patent infringement case brought by Bristol-Myers Squibb. The court ruled that Bristol-Myers Squibb's patent was valid and provided protection until November 2011.Generic clopidogrel is also produced by several pharmaceutical companies in India at significantly lower retail prices, up to 1/30th of the price.Counterfeit Plavix is in circulation, as with many popular medicines.
Health regulators in the United States reported on Monday that they are reviewing the effectiveness of the widely used anticoagulant Plavix, made by Sanofi-Aventis SA and Bristol-Myers Squibb, in some patients.The U.S. Food and Drug Administration (FDA) will be working with the makerâs of the anti-stroke medication Plavix to enable a better understanding of the drug and its effects on the body, especially when taken with another class of drugs. . Before taking Plavix, patients should evaluate and be familiar with the side effects.Plavix is a drug created to prevent unwanted blood clotting.... Used to prevent blood clots after a heart attack or stroke, and for people with disorders that cause blood clotting in the heart and blood vessels, Plavix and does have some unwanted side effects. But this common drug combinationraised the likelihood of returning to the hospital with more heart problems, or death from any cause, by about 25 percent.Euflexxa Lipitor Actonel Fosamax Effexor Protonix Plavix Celebrex Flomax Nexium Synvisc Prevacid Evista Juvederm Orthovisc Restylane Zyprexa HyalganPlavix, a popular anti-clotting drug, could soon have new information added to its label detailing genetic factors that might inhibit its effectiveness.Of late, people are frequently experiencing heart attacks and strokes, and sometimes these attacks
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Indicated for the reduction of atherosclerotic events (myocardial infarction, stroke and vascular death) in patients with atherosclerosis documented by recent stroke, recent ...
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