Dosing & Uses
Dosage Forms & Strengths
tablet
- 75mg
- 300mg
Acute Coronary Syndrome
Unstable angina, non-ST-segment elevation MI (NSTEMI): 300 mg loading dose; initiating therapy without a loading dose will delay establishment of antiplatelet effect by several days; following the loading dose, administer 75 mg/day PO for up to 12 months; may administer beyond 12 months if used in combination with aspirin (75-100 mg/day); long-term combination therapy with aspirin, following stent placement, is individualized depending on how a patient tolerates long-term dual antiplatelet therapy (DAPT), whether they have stable coronary artery disease, and do NOT have risk factors (eg, TIA or stroke, age >75 years, bleeding risk, low body wt, concurrent medications)
ST-segment elevation MI (STEMI): 75 mg/day PO in combination with aspirin 162-325 mg/day and then 81-162 mg/day
<75 years
- 300 mg loading dose followed by 75 mg for 14 days up to 12 months (if no bleeding)
- Concomitant therapy with aspirin: Administer in combination with aspirin 75-325 mg qDay with or without thrombolytics
>75 years
- No loading dose
- 75 mg for 14 days up to 12 months (if no bleeding)
Recent MI, Stroke, or Established Peripheral Arterial Disease
75 mg PO qDay without a loading dose; recommended as alternative to aspirin or concomitantly with aspirin if patient not at increased risk for bleeding but at high risk for cardiovascular disease
Coronary Artery Disease
75 mg PO qDay
Cardioembolic Stroke
Prophylaxis if patient not candidate for oral anticoagulation
75 mg/day PO
Carotid Artery Stenting (Off-label)
300 mg PO plus aspirin 81-325 mg for 1 dose on day before carotid artery stenting (CAS), then 75 mg/day PO plus aspirin 81-325 mg/day for at least 30 days after CAS
Alternative: 300-600 mg PO once, then 75 mg/day for 4 days before CAS in combination with aspirin 81-325 mg/day
Dosage Modifications
Renal impairment: Dose adjustment not necessary
Hepatic impairment: Use caution; experience limited
Dosing Considerations
CYP2C19 poor metabolizers associated with diminished antiplatelet response to clopidogrel; although higher-dose regimen (600 mg loading dose followed by 150 mg once daily) in poor metabolizers increases antiplatelet response, no appropriate dosing regimen for poor metabolizers has been established in clinical outcome trials
Not recommended
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (2)
- abrocitinib
abrocitinib and clopidogrel both increase anticoagulation. Contraindicated. Antiplatelet drugs, except for low-dose aspirin (=81 mg qDay), during the first 3 months of treatment are contraindicated.
- ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC)
clopidogrel will increase the level or effect of ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC) by decreasing metabolism. Contraindicated. Strong CYP2C8 inhibitors are shown to increase dasabuvir plasma concentrations (~10-fold), and therefore increase risk of QT prolongation
Serious - Use Alternative (40)
- antithrombin alfa
antithrombin alfa, clopidogrel. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.
- antithrombin III
antithrombin III, clopidogrel. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.
- apixaban
clopidogrel and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.
- argatroban
argatroban, clopidogrel. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.
- aspirin rectal
aspirin rectal increases effects of clopidogrel by pharmacodynamic synergism. Avoid or Use Alternate Drug. Enhanced risk of hemorrhage.
- bivalirudin
bivalirudin, clopidogrel. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.
- cangrelor
cangrelor decreases effects of clopidogrel by receptor binding competition. Avoid or Use Alternate Drug. The expected antiplatelet effect of a 600 mg loading dose of clopidogrel was blocked when clopidogrel was administered during a cangrelor infusion. Therefore, clopidogrel should not be administered until cangrelor infusion is discontinued.
- carbamazepine
carbamazepine will increase the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. CYP3A4 inducers may increase the metabolism of clopidogrel to its active metabolite. Monitor patients for potential increase in antiplatelet effects when CYP3A4 inducers are used in combination with clopidogrel
- cimetidine
cimetidine decreases effects of clopidogrel by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Clopidogrel efficacy may be reduced by drugs that inhibit CYP2C19. Inhibition of platelet aggregation by clopidogrel is entirely due to an active metabolite. Clopidogrel is metabolized to this active metabolite in part by CYP2C19. .
- clarithromycin
clarithromycin will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Inhibition of CYP3A4 will reduce clopidogrel bioactivation
- dalteparin
dalteparin, clopidogrel. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.
- efavirenz
efavirenz decreases effects of clopidogrel by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Clopidogrel efficacy may be reduced by drugs that inhibit CYP2C19. Inhibition of platelet aggregation by clopidogrel is entirely due to an active metabolite. Clopidogrel is metabolized to this active metabolite in part by CYP2C19. .
- erythromycin base
erythromycin base will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Inhibition of CYP3A4 will reduce clopidogrel bioactivation
- erythromycin ethylsuccinate
erythromycin ethylsuccinate will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Inhibition of CYP3A44 will reduce clopidogrel bioactivation
- erythromycin lactobionate
erythromycin lactobionate will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Inhibition of CYP3A4 will reduce clopidogrel bioactivation
- erythromycin stearate
erythromycin stearate will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Inhibition of CYP3A4 will reduce clopidogrel bioactivation
- eslicarbazepine acetate
eslicarbazepine acetate decreases effects of clopidogrel by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Clopidogrel is metabolized by CYP2C19 enzyme to its active metabolite. Concomitant use of clopidogrel and CYP2C19 inhibitors may decrease plasma concentrations of the active metabolite of clopidogrel and reduction in platelet inhibition.
- esomeprazole
esomeprazole decreases effects of clopidogrel by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Clopidogrel efficacy may be reduced by drugs that inhibit CYP2C19. Inhibition of platelet aggregation by clopidogrel is entirely due to an active metabolite. Clopidogrel is metabolized to this active metabolite in part by CYP2C19. .
- etravirine
etravirine decreases effects of clopidogrel by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Clopidogrel efficacy may be reduced by drugs that inhibit CYP2C19. Inhibition of platelet aggregation by clopidogrel is entirely due to an active metabolite. Clopidogrel is metabolized to this active metabolite in part by CYP2C19. .
- felbamate
felbamate decreases effects of clopidogrel by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Clopidogrel efficacy may be reduced by drugs that inhibit CYP2C19. Inhibition of platelet aggregation by clopidogrel is entirely due to an active metabolite. Clopidogrel is metabolized to this active metabolite in part by CYP2C19. .
- fluconazole
fluconazole decreases effects of clopidogrel by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Clopidogrel efficacy may be reduced by drugs that inhibit CYP2C19. Inhibition of platelet aggregation by clopidogrel is entirely due to an active metabolite. Clopidogrel is metabolized to this active metabolite in part by CYP2C19. .
- fluoxetine
fluoxetine decreases effects of clopidogrel by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Clopidogrel efficacy may be reduced by drugs that inhibit CYP2C19. Inhibition of platelet aggregation by clopidogrel is entirely due to an active metabolite. Clopidogrel is metabolized to this active metabolite in part by CYP2C19. .
- fluvoxamine
fluvoxamine decreases effects of clopidogrel by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Clopidogrel efficacy may be reduced by drugs that inhibit CYP2C19. Inhibition of platelet aggregation by clopidogrel is entirely due to an active metabolite. Clopidogrel is metaolized to this active metabolite in part by CYP2C19.
- fondaparinux
fondaparinux, clopidogrel. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.
- isoniazid
isoniazid decreases effects of clopidogrel by decreasing metabolism. Avoid or Use Alternate Drug. Cytochrome P450 2C19 inhibitors decrease the conversion of clopidogrel to its active form.
- ketoconazole
ketoconazole decreases effects of clopidogrel by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Clopidogrel efficacy may be reduced by drugs that inhibit CYP2C19. Inhibition of platelet aggregation by clopidogrel is entirely due to an active metabolite. Clopidogrel is metabolized to this active metabolite in part by CYP2C19. .
- modafinil
modafinil decreases effects of clopidogrel by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Clopidogrel efficacy may be reduced by drugs that inhibit CYP2C19. Inhibition of platelet aggregation by clopidogrel is entirely due to an active metabolite. Clopidogrel is metabolized to this active metabolite in part by CYP2C19. .
- morphine
morphine will decrease the level or effect of clopidogrel by Other (see comment). Avoid or Use Alternate Drug. coadministration of opioid agonists delay and reduce absorption of clopidogrel, presumably because of slowed gastric emptying, resulting in reduced exposure to its metabolites; consider use of parenteral antiplatelet agents in acute coronary syndrome patients requiring coadministration of morphine or other opioid agonists
- nefazodone
nefazodone will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Inhibition of CYP3A4 will reduce clopidogrel bioactivation
- omeprazole
omeprazole decreases effects of clopidogrel by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Clopidogrel efficacy may be reduced by drugs that inhibit CYP2C19. Inhibition of platelet aggregation by clopidogrel is entirely due to an active metabolite. Clopidogrel is metabolized to this active metabolite in part by CYP2C19. .
- oxcarbazepine
oxcarbazepine decreases effects of clopidogrel by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Clopidogrel efficacy may be reduced by drugs that inhibit CYP2C19. Inhibition of platelet aggregation by clopidogrel is entirely due to an active metabolite. Clopidogrel is metabolized to this active metabolite in part by CYP2C19. .
- protamine
protamine, clopidogrel. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.
- rabeprazole
rabeprazole decreases effects of clopidogrel by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Clopidogrel efficacy may be reduced by drugs that inhibit CYP2C19. Inhibition of platelet aggregation by clopidogrel is entirely due to an active metabolite. Clopidogrel is metabolized to this active metabolite in part by CYP2C19. .
- repaglinide
clopidogrel will increase the level or effect of repaglinide by Other (see comment). Avoid or Use Alternate Drug. Clopidogrel inhibits CYP2C8. Coadministration significantly increases repaglinide serum levels. If unable to avoid coadministration, decrease initial repaglinide dose to 0.5 mg/meal and do not exceed 4 mg/day.
- rifabutin
rifabutin will increase the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. CYP3A4 inducers may increase the metabolism of clopidogrel to its active metabolite. Monitor patients for potential increase in antiplatelet effects when CYP3A4 inducers are used in combination with clopidogrel
- rifampin
rifampin will increase the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. CYP3A4 inducers may increase the metabolism of clopidogrel to its active metabolite. Monitor patients for potential increase in antiplatelet effects when CYP3A4 inducers are used in combination with clopidogrel
- St John's Wort
St John's Wort will increase the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. CYP3A4 inducers may increase the metabolism of clopidogrel to its active metabolite. Monitor patients for potential increase in antiplatelet effects when CYP3A4 inducers are used in combination with clopidogrel
- ticlopidine
ticlopidine decreases effects of clopidogrel by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Clopidogrel efficacy may be reduced by drugs that inhibit CYP2C19. Inhibition of platelet aggregation by clopidogrel is entirely due to an active metabolite. Clopidogrel is metabolized to this active metabolite in part by CYP2C19. .
- tucatinib
clopidogrel will increase the level or effect of tucatinib by Other (see comment). Avoid or Use Alternate Drug. Coadministration of tucatinib (a CYP2C8 substrate) with a strong or moderate CYP2C8 inhibitors increases tucatinib plasma concentrations and risk of toxicities.
- voriconazole
voriconazole decreases effects of clopidogrel by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Clopidogrel efficacy may be reduced by drugs that inhibit CYP2C19. Inhibition of platelet aggregation by clopidogrel is entirely due to an active metabolite. Clopidogrel is metabolized to this active metabolite in part by CYP2C19. .
Monitor Closely (141)
- acalabrutinib
acalabrutinib increases effects of clopidogrel by anticoagulation. Modify Therapy/Monitor Closely. Coadministration of acalabrutinib with antiplatelets or anticoagulants may further increase risk of hemorrhage. Monitor for signs of bleeding and consider the benefit-risk of withholding acalabrutinib for 3-7 days presurgery and postsurgery depending upon the type of surgery and the risk of bleeding.
- amobarbital
amobarbital will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- apalutamide
clopidogrel will increase the level or effect of apalutamide by Other (see comment). Use Caution/Monitor. Coadministration of apalutamide with strong CYP2C8 inhibitors does not require initial dosage modification; however, dose reduction may be needed based on tolerability.
- aprepitant
aprepitant will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Inhibition of CYP3A4 will reduce clopidogrel bioactivation
- armodafinil
armodafinil will increase the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers may increase the metabolism of clopidogrel to its active metabolite. Monitor patients for potential increase in antiplatelet effects when CYP3A4 inducers are used in combination with clopidogrel
armodafinil decreases effects of clopidogrel by decreasing metabolism. Use Caution/Monitor. Cytochrome P450 2C19 inhibitors decrease the conversion of clopidogrel to its active form. - artemether/lumefantrine
artemether/lumefantrine will increase the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers may increase the metabolism of clopidogrel to its active metabolite. Monitor patients for potential increase in antiplatelet effects when CYP3A4 inducers are used in combination with clopidogrel
- aspirin
aspirin, clopidogrel. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.
- aspirin rectal
clopidogrel, aspirin rectal. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Clopidogrel and NSAIDs both inhibit platelet aggregation.
- aspirin/citric acid/sodium bicarbonate
aspirin/citric acid/sodium bicarbonate, clopidogrel. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.
- atazanavir
atazanavir will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Inhibition of CYP3A4 will reduce clopidogrel bioactivation
- atogepant
clopidogrel will decrease the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- azficel-T
azficel-T, clopidogrel. Other (see comment). Use Caution/Monitor. Comment: Coadministration with anticoagulants or antiplatelets may increase bruising or bleeding at biopsy and/or injection sites; concomitant use not recommended. Decisions regarding continued use or cessation of anticoagulants or antiplatelets should be made by a physician.
- betrixaban
clopidogrel, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.
- bortezomib
bortezomib decreases effects of clopidogrel by decreasing metabolism. Use Caution/Monitor. Avoid concurrent use of CYP2C19 inhibitors with clopidogrel. Due to the thrombocytopenic effects of bortezomib, an additive risk of bleeding may be seen in patients receiving concomitant platelet inhibitors.
- bosentan
bosentan will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers may increase the metabolism of clopidogrel to its active metabolite. Monitor patients for potential increase in antiplatelet effects when CYP3A4 inducers are used in combination with clopidogrel
- budesonide
budesonide will increase the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers may increase the metabolism of clopidogrel to its active metabolite. Monitor patients for potential increase in antiplatelet effects when CYP3A4 inducers are used in combination with clopidogrel
- bupropion
clopidogrel will increase the level or effect of bupropion by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor. Plasma concentrations of bupropion may be significantly increased when coadministered with clopidogrel or other CYP2B6 inhibitors. The increase in plasma bupropion concentrations may cause an increase in adverse reactions including tremor, headache, insomnia, dry mouth, nausea, or seizures.
- butabarbital
butabarbital will increase the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers may increase the metabolism of clopidogrel to its active metabolite. Monitor patients for potential increase in antiplatelet effects when CYP3A4 inducers are used in combination with clopidogrel
- butalbital
butalbital will increase the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers may increase the metabolism of clopidogrel to its active metabolite. Monitor patients for potential increase in antiplatelet effects when CYP3A4 inducers are used in combination with clopidogrel
- caplacizumab
caplacizumab, clopidogrel. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.
- celecoxib
clopidogrel, celecoxib. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Clopidogrel and NSAIDs both inhibit platelet aggregation.
- choline magnesium trisalicylate
clopidogrel, choline magnesium trisalicylate. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Clopidogrel and NSAIDs both inhibit platelet aggregation.
- cimetidine
cimetidine decreases effects of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Clopidogrel efficacy may be reduced by drugs that inhibit CYP3A4. Inhibition of platelet aggregation by clopidogrel is entirely due to an active metabolite. Clopidogrel is metabolized to this active metabolite in part by CYP3A4. .
- citalopram
citalopram increases effects of clopidogrel by pharmacodynamic synergism. Use Caution/Monitor. SSRIs affect platelet activation; coadministration of SSRIs with clopidogrel may increase the risk of bleeding.
- conivaptan
conivaptan will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Inhibition of CYP3A4 will reduce clopidogrel bioactivation
- cortisone
cortisone will increase the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers may increase the metabolism of clopidogrel to its active metabolite. Monitor patients for potential increase in antiplatelet effects when CYP3A4 inducers are used in combination with clopidogrel
- cyclosporine
cyclosporine will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Inhibition of CYP3A4 will reduce clopidogrel bioactivation
- dabigatran
dabigatran, clopidogrel. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs have the potential to cause bleeding. Concomitant use may increase risk of bleeding.
- darifenacin
darifenacin will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Inhibition of CYP3A4 will reduce clopidogrel bioactivation
- darunavir
darunavir will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Inhibition of CYP3A4 will reduce clopidogrel bioactivation
- dasatinib
dasatinib will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Inhibition of CYP3A4 will reduce clopidogrel bioactivation
- deferasirox
deferasirox, clopidogrel. Other (see comment). Use Caution/Monitor. Comment: Gastric ulceration and GI bleeding have been reported in patients taking deferasirox, use caution when coadministering with other drugs known to increase the risk of peptic ulcers or gastric hemorrhage including anticoagulants.
- defibrotide
defibrotide increases effects of clopidogrel by Other (see comment). Use Caution/Monitor. Comment: Defibrotide may enhance effects of platelet inhibitors.
- desvenlafaxine
desvenlafaxine increases effects of clopidogrel by pharmacodynamic synergism. Use Caution/Monitor. SNRIs affect platelet activation; coadministration of SNRIs with clopidogrel may increase the risk of bleeding.
- dexamethasone
dexamethasone will increase the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers may increase the metabolism of clopidogrel to its active metabolite. Monitor patients for potential increase in antiplatelet effects when CYP3A4 inducers are used in combination with clopidogrel
- dexlansoprazole
dexlansoprazole decreases effects of clopidogrel by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Mean AUC of clopidogrel active metabolite was reduced by ~9% when dexlansoprazole was coadministered compared to administration of clopidogrel alone in healthy subjects who were CYP2C19 extensive metabolizers. Clopidogrel efficacy may be reduced by drugs that inhibit CYP2C19. Inhibition of platelet aggregation by clopidogrel is entirely due to the active clopidogrel metabolite. Clopidogrel is metabolized in part by CYP2C19.
- DHEA, herbal
DHEA, herbal will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Inhibition of CYP3A4 will reduce clopidogrel bioactivation
- diclofenac
clopidogrel, diclofenac. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Clopidogrel and NSAIDs both inhibit platelet aggregation.
- diflunisal
clopidogrel, diflunisal. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Clopidogrel and NSAIDs both inhibit platelet aggregation.
- diltiazem
diltiazem will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of clopidogrel and a calcium channel blocking agent may decrease the effect of clopidogrel on platelet inhibition, possibly increasing the risk of atherothrombotic events. Clopidogrel requires hepatic biotransformation to an active metabolite, mediated by the 3A4 enzyme. Diltiazem is a 3A4 inhibitor and may decrease the hepatic metabolism of clopidogrel to its active metabolite.
- dronedarone
dronedarone will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Inhibition of CYP3A4 will reduce clopidogrel bioactivation
- duloxetine
duloxetine increases effects of clopidogrel by pharmacodynamic synergism. Use Caution/Monitor. SNRIs affect platelet activation; coadministration of SNRIs with clopidogrel may increase the risk of bleeding.
- edoxaban
edoxaban, clopidogrel. Either increases toxicity of the other by anticoagulation. Modify Therapy/Monitor Closely. Both drugs have the potential to cause bleeding. The need for simultaneous use of platelet aggregation inhibitors with anticoagulants is common for patients with cardiovascular disease, but may result in increased bleeding; monitor closely. Promptly evaluate any signs or symptoms of blood loss.
- efavirenz
efavirenz decreases effects of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Clopidogrel efficacy may be reduced by drugs that inhibit CYP3A4. Inhibition of platelet aggregation by clopidogrel is entirely due to an active metabolite. Clopidogrel is metabolized to this active metabolite in part by CYP3A4. .
- enoxaparin
enoxaparin, clopidogrel. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Enhanced risk of hemorrhage; additive effects are intended when both drugs are prescribed as indicated for ACS.
- escitalopram
escitalopram increases effects of clopidogrel by pharmacodynamic synergism. Use Caution/Monitor. SSRIs affect platelet activation; coadministration of SSRIs with clopidogrel may increase the risk of bleeding.
- eslicarbazepine acetate
eslicarbazepine acetate will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Clopidogrel efficacy may be reduced by drugs that inhibit CYP3A4. Inhibition of platelet aggregation by clopidogrel is entirely due to an active metabolite. Clopidogrel is metabolized to this active metabolite in part by CYP3A4.
- etodolac
clopidogrel, etodolac. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Clopidogrel and NSAIDs both inhibit platelet aggregation.
- etravirine
etravirine decreases effects of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Clopidogrel efficacy may be reduced by drugs that inhibit CYP3A4. Inhibition of platelet aggregation by clopidogrel is entirely due to an active metabolite. Clopidogrel is metabolized to this active metabolite in part by CYP3A4. .
- felodipine
felodipine decreases effects of clopidogrel by decreasing metabolism. Use Caution/Monitor. Cytochrome P450 2C19 inhibitors decrease the conversion of clopidogrel to its active form.
- fenoprofen
clopidogrel, fenoprofen. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Clopidogrel and NSAIDs both inhibit platelet aggregation.
- fish oil
fish oil, clopidogrel. Other (see comment). Use Caution/Monitor. Comment: Patients taking fish oil and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding. .
- fish oil triglycerides
fish oil triglycerides will increase the level or effect of clopidogrel by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.
- fluconazole
fluconazole increases effects of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Clopidogrel efficacy may be reduced by drugs that inhibit CYP3A4. Inhibition of platelet aggregation by clopidogrel is entirely due to an active metabolite. Clopidogrel is metabolized to this active metabolite in part by CYP3A4. .
- fludrocortisone
fludrocortisone will increase the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers may increase the metabolism of clopidogrel to its active metabolite. Monitor patients for potential increase in antiplatelet effects when CYP3A4 inducers are used in combination with clopidogrel
- fluoxetine
fluoxetine increases effects of clopidogrel by pharmacodynamic synergism. Use Caution/Monitor. SSRIs affect platelet activation; coadministration of SSRIs with clopidogrel may increase the risk of bleeding.
- flurbiprofen
clopidogrel, flurbiprofen. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Clopidogrel and NSAIDs both inhibit platelet aggregation.
- fluvoxamine
fluvoxamine will increase the level or effect of clopidogrel by pharmacodynamic synergism. Use Caution/Monitor. SSRIs affect platelet activation; coadministration may increase risk of bleeding
- fosamprenavir
fosamprenavir will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Inhibition of CYP3A4 will reduce clopidogrel bioactivation
- fosphenytoin
fosphenytoin will increase the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers may increase the metabolism of clopidogrel to its active metabolite. Monitor patients for potential increase in antiplatelet effects when CYP3A4 inducers are used in combination with clopidogrel
- grapefruit
grapefruit will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Inhibition of CYP3A4 will reduce clopidogrel bioactivation
- green tea
green tea increases effects of clopidogrel by pharmacodynamic synergism. Use Caution/Monitor. (Theoretical interaction). Combination may increase risk of bleeding.
- griseofulvin
griseofulvin will increase the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers may increase the metabolism of clopidogrel to its active metabolite. Monitor patients for potential increase in antiplatelet effects when CYP3A4 inducers are used in combination with clopidogrel
- heparin
heparin, clopidogrel. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Enhanced risk of hemorrhage; additive effects are intended when both drugs are prescribed as indicated for ACS.
- hydrocortisone
hydrocortisone will increase the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers may increase the metabolism of clopidogrel to its active metabolite. Monitor patients for potential increase in antiplatelet effects when CYP3A4 inducers are used in combination with clopidogrel
- ibrutinib
ibrutinib will increase the level or effect of clopidogrel by anticoagulation. Use Caution/Monitor. Ibrutinib may increase the risk of hemorrhage in patients receiving antiplatelet or anticoagulant therapies and monitor for signs of bleeding.
- ibuprofen
clopidogrel, ibuprofen. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Clopidogrel and NSAIDs both inhibit platelet aggregation.
- ibuprofen IV
clopidogrel, ibuprofen IV. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Clopidogrel and NSAIDs both inhibit platelet aggregation.
- icosapent
icosapent, clopidogrel. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Icosapent may prolong bleeding time; monitor periodically if coadministered with other drugs that affect bleeding.
- indinavir
indinavir will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Inhibition of CYP3A4 will reduce clopidogrel bioactivation
- indomethacin
clopidogrel, indomethacin. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Clopidogrel and NSAIDs both inhibit platelet aggregation.
- isoniazid
isoniazid will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Inhibition of CYP3A4 will reduce clopidogrel bioactivation
- ketoconazole
ketoconazole decreases effects of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Clopidogrel efficacy may be reduced by drugs that inhibit CYP3A4. Inhibition of platelet aggregation by clopidogrel is entirely due to an active metabolite. Clopidogrel is metabolized to this active metabolite in part by CYP3A4. .
- ketoprofen
clopidogrel, ketoprofen. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Clopidogrel and NSAIDs both inhibit platelet aggregation.
- ketorolac
clopidogrel, ketorolac. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Clopidogrel and NSAIDs both inhibit platelet aggregation.
- ketorolac intranasal
clopidogrel, ketorolac intranasal. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Clopidogrel and NSAIDs both inhibit platelet aggregation.
- lansoprazole
lansoprazole decreases effects of clopidogrel by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Mean AUC of clopidogrel active metabolite was reduced by ~14% when lansoprazole was coadministered compared to administration of clopidogrel alone in healthy subjects who were CYP2C19 extensive metabolizers. Clopidogrel efficacy may be reduced by drugs that inhibit CYP2C19. Inhibition of platelet aggregation by clopidogrel is entirely due to the active clopidogrel metabolite. Clopidogrel is metabolized in part by CYP2C19.
- lapatinib
lapatinib will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Inhibition of CYP3A4 will reduce clopidogrel bioactivation
- letermovir
letermovir increases levels of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- levomilnacipran
levomilnacipran increases effects of clopidogrel by pharmacodynamic synergism. Use Caution/Monitor. SNRIs affect platelet activation; coadministration of SNRIs with clopidogrel may increase the risk of bleeding.
- lumefantrine
lumefantrine will increase the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers may increase the metabolism of clopidogrel to its active metabolite. Monitor patients for potential increase in antiplatelet effects when CYP3A4 inducers are used in combination with clopidogrel
- marijuana
marijuana will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Inhibition of CYP3A4 will reduce clopidogrel bioactivation
- meclofenamate
clopidogrel, meclofenamate. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Clopidogrel and NSAIDs both inhibit platelet aggregation.
- mefenamic acid
clopidogrel, mefenamic acid. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Clopidogrel and NSAIDs both inhibit platelet aggregation.
- melatonin
melatonin increases effects of clopidogrel by anticoagulation. Use Caution/Monitor. Melatonin may decrease prothrombin time.
- meloxicam
clopidogrel, meloxicam. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Clopidogrel and NSAIDs both inhibit platelet aggregation.
- methylprednisolone
methylprednisolone will increase the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers may increase the metabolism of clopidogrel to its active metabolite. Monitor patients for potential increase in antiplatelet effects when CYP3A4 inducers are used in combination with clopidogrel
- metronidazole
metronidazole will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Inhibition of CYP3A4 will reduce clopidogrel bioactivation
- miconazole vaginal
miconazole vaginal will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Inhibition of CYP3A4 will reduce clopidogrel bioactivation
- milnacipran
milnacipran increases effects of clopidogrel by pharmacodynamic synergism. Use Caution/Monitor. SNRIs affect platelet activation; coadministration of SNRIs with clopidogrel may increase the risk of bleeding.
- mipomersen
mipomersen, clopidogrel. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Both drugs have potential to increase hepatic enzymes; monitor LFTs.
- modafinil
modafinil decreases effects of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Clopidogrel efficacy may be reduced by drugs that inhibit CYP3A4. Inhibition of platelet aggregation by clopidogrel is entirely due to an active metabolite. Clopidogrel is metabolized to this active metabolite in part by CYP3A4. .
- nabumetone
clopidogrel, nabumetone. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Clopidogrel and NSAIDs both inhibit platelet aggregation.
- naproxen
clopidogrel, naproxen. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Clopidogrel and NSAIDs both inhibit platelet aggregation.
- nelfinavir
nelfinavir will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Inhibition of CYP3A4 will reduce clopidogrel bioactivation
- nevirapine
nevirapine will increase the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers may increase the metabolism of clopidogrel to its active metabolite. Monitor patients for potential increase in antiplatelet effects when CYP3A4 inducers are used in combination with clopidogrel
- nilotinib
nilotinib will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Inhibition of CYP3A4 will reduce clopidogrel bioactivation
- nilutamide
nilutamide will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Inhibition of CYP3A4 will reduce clopidogrel bioactivation
- omega 3 carboxylic acids
omega 3 carboxylic acids, clopidogrel. Other (see comment). Use Caution/Monitor. Comment: Patients taking omega-3 acids and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding.
- omega 3 fatty acids
omega 3 fatty acids, clopidogrel. Other (see comment). Use Caution/Monitor. Comment: Patients taking omega-3-fatty acids and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding. .
- oseltamivir
clopidogrel decreases levels of oseltamivir by Other (see comment). Use Caution/Monitor. Comment: Clopidogrel may decrease serum concentrations of active metabolite(s) of oseltamivir. .
- oxaprozin
clopidogrel, oxaprozin. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Clopidogrel and NSAIDs both inhibit platelet aggregation.
- oxcarbazepine
oxcarbazepine decreases effects of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Clopidogrel efficacy may be reduced by drugs that inhibit CYP3A4. Inhibition of platelet aggregation by clopidogrel is entirely due to an active metabolite. Clopidogrel is metabolized to this active metabolite in part by CYP3A4. .
- pantoprazole
pantoprazole decreases effects of clopidogrel by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Clopidogrel efficacy may be reduced by drugs that inhibit CYP2C19. Inhibition of platelet aggregation by clopidogrel is entirely due to the active clopidogrel metabolite. Clopidogrel is metabolized in part by CYP2C19. Pantoprazole prescribing information state that coadministration with clopidogrel had no clinically important effect on exposure to clopidogrel active metabolite; no dose adjustment of clopidogrel is required .
- parecoxib
parecoxib decreases effects of clopidogrel by decreasing metabolism. Use Caution/Monitor. Cytochrome P450 2C19 inhibitors decrease the conversion of clopidogrel to its active form.
- paroxetine
paroxetine increases effects of clopidogrel by pharmacodynamic synergism. Use Caution/Monitor. SSRIs affect platelet activation; coadministration of SSRIs with clopidogrel may increase the risk of bleeding.
- pentobarbital
pentobarbital will increase the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers may increase the metabolism of clopidogrel to its active metabolite. Monitor patients for potential increase in antiplatelet effects when CYP3A4 inducers are used in combination with clopidogrel
- phenobarbital
phenobarbital will increase the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers may increase the metabolism of clopidogrel to its active metabolite. Monitor patients for potential increase in antiplatelet effects when CYP3A4 inducers are used in combination with clopidogrel
- phenytoin
phenytoin will increase the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers may increase the metabolism of clopidogrel to its active metabolite. Monitor patients for potential increase in antiplatelet effects when CYP3A4 inducers are used in combination with clopidogrel
- piracetam
piracetam increases effects of clopidogrel by pharmacodynamic synergism. Use Caution/Monitor.
- piroxicam
clopidogrel, piroxicam. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Clopidogrel and NSAIDs both inhibit platelet aggregation.
- porfimer
clopidogrel decreases effects of porfimer by pharmacodynamic antagonism. Use Caution/Monitor.
- posaconazole
posaconazole will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Inhibition of CYP3A4 will reduce clopidogrel bioactivation
- prednisone
prednisone will increase the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers may increase the metabolism of clopidogrel to its active metabolite. Monitor patients for potential increase in antiplatelet effects when CYP3A4 inducers are used in combination with clopidogrel
- primidone
primidone will increase the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers may increase the metabolism of clopidogrel to its active metabolite. Monitor patients for potential increase in antiplatelet effects when CYP3A4 inducers are used in combination with clopidogrel
- quinupristin/dalfopristin
quinupristin/dalfopristin will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Inhibition of CYP3A4 will reduce clopidogrel bioactivation
- rifapentine
rifapentine will increase the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers may increase the metabolism of clopidogrel to its active metabolite. Monitor patients for potential increase in antiplatelet effects when CYP3A4 inducers are used in combination with clopidogrel
- ritonavir
ritonavir will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Inhibition of CYP3A4 will reduce clopidogrel bioactivation
- rivaroxaban
rivaroxaban, clopidogrel. Other (see comment). Use Caution/Monitor. Comment: Avoid concurrent administration of clopidogrel with rivaroxaban unless the benefit outweighs the risk of increased bleeding. .
- rufinamide
rufinamide will increase the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers may increase the metabolism of clopidogrel to its active metabolite. Monitor patients for potential increase in antiplatelet effects when CYP3A4 inducers are used in combination with clopidogrel
- salsalate
clopidogrel, salsalate. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Clopidogrel and NSAIDs both inhibit platelet aggregation.
- secobarbital
secobarbital will increase the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers may increase the metabolism of clopidogrel to its active metabolite. Monitor patients for potential increase in antiplatelet effects when CYP3A4 inducers are used in combination with clopidogrel
- selexipag
clopidogrel will increase the level or effect of selexipag by decreasing metabolism. Use Caution/Monitor. Selexipag is a ABCG2 (BCRP) substrate. Monitor selexipag for increased pharmacologic or adverse effects when coadministered with ABCG2 (BCRP) inhibitors.
- selumetinib
clopidogrel and selumetinib both increase anticoagulation. Modify Therapy/Monitor Closely. An increased risk of bleeding may occur in patients taking a vitamin-K antagonist or an antiplatelet agent with selumetinib. Monitor for bleeding and INR or PT in patients coadministered a vitamin-K antagonist or an antiplatelet agent with selumetinib.
- sertraline
sertraline increases effects of clopidogrel by pharmacodynamic synergism. Use Caution/Monitor. SSRIs affect platelet activation; coadministration of SSRIs with clopidogrel may increase the risk of bleeding.
- sodium zirconium cyclosilicate
sodium zirconium cyclosilicate will decrease the level or effect of clopidogrel by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Clopidogrel active metabolite may be decreased. Separate administration by at least 2 hr.
- sulfasalazine
clopidogrel, sulfasalazine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Clopidogrel and NSAIDs both inhibit platelet aggregation.
- sulindac
clopidogrel, sulindac. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Clopidogrel and NSAIDs both inhibit platelet aggregation.
- tazemetostat
clopidogrel will decrease the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- ticagrelor
ticagrelor, clopidogrel. Either increases effects of the other by Other (see comment). Use Caution/Monitor. Comment: Increased risk of bleeding during concomitant use of medications that increase potential for bleeding.
- tolmetin
clopidogrel, tolmetin. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Clopidogrel and NSAIDs both inhibit platelet aggregation.
- topiramate
topiramate will increase the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers may increase the metabolism of clopidogrel to its active metabolite. Monitor patients for potential increase in antiplatelet effects when CYP3A4 inducers are used in combination with clopidogrel
- triamcinolone acetonide injectable suspension
triamcinolone acetonide injectable suspension will increase the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers may increase the metabolism of clopidogrel to its active metabolite. Monitor patients for potential increase in antiplatelet effects when CYP3A4 inducers are used in combination with clopidogrel
- ubrogepant
clopidogrel will decrease the level or effect of ubrogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Dose adjustment is recommended with concomitant use of ubrogepant and moderate and weak CYP3A4 inducers. (see Dosage Modifications)
- venlafaxine
venlafaxine increases effects of clopidogrel by pharmacodynamic synergism. Use Caution/Monitor. SNRIs affect platelet activation; coadministration of SNRIs with clopidogrel may increase the risk of bleeding.
- verapamil
verapamil will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Inhibition of CYP3A4 will reduce clopidogrel bioactivation
- vorapaxar
clopidogrel, vorapaxar. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Coadministration of anticoagulants, antiplatelets, or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding.
- voriconazole
voriconazole decreases effects of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Clopidogrel efficacy may be reduced by drugs that inhibit CYP3A4. Inhibition of platelet aggregation by clopidogrel is entirely due to an active metabolite. Clopidogrel is metabolized to this active metabolite in part by CYP3A4. .
- vortioxetine
clopidogrel, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.
- warfarin
warfarin, clopidogrel. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Enhanced risk of hemorrhage; additive effects may occur when simultaneous use is clinically required .
- zafirlukast
zafirlukast will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Inhibition of CYP3A4 will reduce clopidogrel bioactivation
Minor (13)
- aspirin rectal
clopidogrel increases levels of aspirin rectal by decreasing metabolism. Minor/Significance Unknown.
- devil's claw
devil's claw, clopidogrel. pharmacodynamic synergism. Minor/Significance Unknown. May prolong bleeding time. Conflicting evidence.ÿ Use with caution.
- ethotoin
clopidogrel increases levels of ethotoin by decreasing metabolism. Minor/Significance Unknown.
- fluvastatin
clopidogrel increases levels of fluvastatin by decreasing metabolism. Minor/Significance Unknown.
- fosphenytoin
clopidogrel increases levels of fosphenytoin by decreasing metabolism. Minor/Significance Unknown.
- ginger
ginger, clopidogrel. pharmacodynamic synergism. Minor/Significance Unknown. May prolong bleeding time. Conflicting evidence. Use with caution.
- ginkgo biloba
ginkgo biloba, clopidogrel. pharmacodynamic synergism. Minor/Significance Unknown. May prolong bleeding time. Conflicting evidence. Use with caution.
- horse chestnut seed
horse chestnut seed, clopidogrel. pharmacodynamic synergism. Minor/Significance Unknown. May prolong bleeding time. Theoretical. Use with caution.
- phenytoin
clopidogrel increases levels of phenytoin by decreasing metabolism. Minor/Significance Unknown.
- salicylates (non-asa)
clopidogrel increases levels of salicylates (non-asa) by decreasing metabolism. Minor/Significance Unknown.
- tolbutamide
clopidogrel increases levels of tolbutamide by decreasing metabolism. Minor/Significance Unknown.
- torsemide
clopidogrel increases levels of torsemide by decreasing metabolism. Minor/Significance Unknown.
- verteporfin
clopidogrel decreases effects of verteporfin by pharmacodynamic antagonism. Minor/Significance Unknown.
Adverse Effects
1-10%
Upper respiratory tract infection (8.7%)
Chest pain (8.3%)
Headache (7.6%)
Flulike syndrome (7.5%)
Arthralgia (6%)
Pain (6%)
Dizziness (6%)
Diarrhea (4.5%)
Rash (4.2%)
Rhinitis (4.2%)
Depression (3.6%)
Urinary tract infection (3.1%)
<1%
Severe neutropenia
Thrombotic thrombocytopenic purpura
Acute liver failure
Aplastic anemia
Hypotension
Hepatitis
Myalgia
Eczema
Erythema
Agranulocytosis
Postmarketing Reports
Blood and lymphatic system disorders: Agranulocytosis, aplastic anemia/pancytopenia, thrombotic thrombocytopenic purpura (TTP), acquired hemophilia A
Eye disorders: Eye (conjunctival, ocular, retinal) bleeding
Gastrointestinal disorders: Gastrointestinal and retroperitoneal hemorrhage with fatal outcome, colitis (including ulcerative or lymphocytic colitis), pancreatitis, stomatitis, gastric/duodenal ulcer, diarrhea
General disorders and administration site condition: Fever, hemorrhage of operative wound
Hepato-biliary disorders: Acute liver failure, hepatitis (non-infectious), abnormal liver function test
Immune system disorders: Hypersensitivity reactions, anaphylactoid reactions, serum sickness
Musculoskeletal, connective tissue and bone disorders: Musculoskeletal bleeding, myalgia, arthralgia, arthritis
Nervous system disorders: Taste disorders, fatal intracranial bleeding, headache
Psychiatric disorders: Confusion, hallucinations
Respiratory, thoracic and mediastinal disorders: Bronchospasm, interstitial pneumonitis, respiratory tract bleeding, eosinophilic pneumonia
Renal and urinary disorders: Increased creatinine levels
Skin and subcutaneous tissue disorders: Maculopapular, erythematous, or exfoliative rash, urticaria, bullous dermatitis, eczema, toxic epidermal necrolysis, Stevens-Johnson syndrome, angioedema, drug-induced hypersensitivity syndrome, drug rash with eosinophilia and systemic symptoms (DRESS), erythema multiforme, skin bleeding, lichen planus, generalized pruritus, acute generalized exanthematous pustulosis (AGEP)
Vascular disorders: Vasculitis, hypotension
Warnings
Black Box Warnings
Clopidogrel's antiplatelet activity is dependent on conversion to an active metabolite by the cytochrome P450 (CYP) system, principally CYP2C19
Tests are available to identify patients who are CYP2C19 poor metabolizers
Consider use of another platelet P2Y12 inhibitor in patients identified as CYP2C19 poor metabolizers
Contraindications
Hypersensitivity
Active pathologic bleeding (eg, peptic ulcer, intracranial hemorrhage)
Cautions
Use with caution in patients with bleeding or platelet disorders
Premature discontinuation increases risk of cardiovascular events; discontinue 5 days prior to elective surgery that has a major risk of bleeding
Use caution in patients with atrial fibrillation; assess bleeding risk carefully; significant increase in major bleeding events reported in patients receiving clopidogrel plus aspirin instead of aspirin alone
Patients allergic to aspirin who are undergoing PCI; see American Heart Association (AHA)/American College of Chest Physicians (ACCP)/American College of Cardiology (ACC) recommendations
Rare but potentially fatal thrombotic thrombocytopenic purpura associated with use
Risk of bleeding with potentially fatal outcome
Hepatic or renal impairment
Allergic cross-reactivity including rash, angioedema, or hematologic reaction among thienopyridines (eg, ticlopidine, prasugrel) reported; evaluate patient for history of hypersensitivity
Use caution in patients with severe hepatic or renal impairment
Use caution or avoid in patients with hypersensitivity or hematologic reactions to previous thienopyridine use, including ticlopidine and prasugrel
Use caution in patients receiving either anticoagulants, including heparin and warfarin, or other platelet aggregation inhibitors; risk of bleeding increases
Premature interruption of therapy may result in stent thrombosis with subsequent fatal and nonfatal myocardial infarction; duration of therapy is determined by type of stent placed
P2Y12 inhibitors (thienopyridines), including clopidogrel, inhibit platelet aggregation for lifetime of platelet (7-10 days); because half-life of clopidogrel’s active metabolite is short, it may be possible to restore hemostasis by administering exogenous platelets; however, platelet transfusions within 4 hours of loading dose or 2 hours of the maintenance dose may be less effective
May increase risk of major hemorrhage in patients with recent lacunar stroke
CYP2C19 inhibition & poor metabolizers
- Metabolism of clopidogrel to its active metabolite can be impaired by genetic variations in CYP2C19
- Clopidogrel is a prodrug and requires CYP2C19 to convert to active metabolite; inhibition of platelet aggregation is entirely due to active metabolite
- CYP2C19*2 and *3 alleles have no functional metabolism of clopidogrel to active metabolite; CYP2C19*4, *5, *6, *7, and *8 may be associated with absent or reduced metabolism of clopidogrel but are less frequent than CYP2C19*2 and *3
- >50% of Asians have CYP2C19 genetic variants that inhibit clopidogrel metabolism
- Use of CYP2C19 inhibitors (eg, proton pump inhibitors [PPIs]) or use in poor metabolizers may decrease formation of active metabolite, thereby decreasing antiplatelet effect; observational studies and 1 randomized clinical trial have shown concomitant use of clopidogrel and PPIs to have inconsistent effects on cardiovascular outcomes
- Use of drugs that induce the activity of CYP2C19 would be expected to result in increased drug levels of the active metabolite of clopidogrel and might potentiate bleeding risk; as a precaution, avoid concomitant use of strong CYP2C19 inducers
Pregnancy & Lactation
Pregnancy
Available data from cases reported over two decades in published literature and postmarketing surveillance have not identified any drug-associated risks for major birth defects or miscarriage; there are risks to pregnant woman and fetus associated with myocardial infarction and stroke
Myocardial infarction and stroke are medical emergencies; therapy for pregnant woman should not be withheld because of potential concerns regarding effects of clopidogrel on the fetus
Labor or delivery
- Therapy during labor or delivery will increase risk of maternal bleeding and hemorrhage; avoid neuraxial blockade during clopidogrel use because of risk of spinal hematoma; when possible, discontinue therapy 5-7 days prior to labor, delivery, or neuraxial blockade
Animal data
- Embryo-fetal development studies performed showed no evidence of fetotoxicity when drug administered to pregnant rats and rabbits during organogenesis at doses corresponding to 65 and 78 times the recommended daily human dose
Lactation
There are no data on presence of drug in human milk or effects on milk production; no adverse effects on breastfed infants observed during lactation in a small number of postmarketing cases; studies in rats have shown that clopidogrel and/or its metabolites are present in milk; when a drug is present in animal milk, it is likely that the drug will be present in human milk; consider developmental and health benefits of breastfeeding along with mother’s clinical need for therapy and any potential adverse effects on breastfed infant from drug or underlying maternal condition
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Inhibitor of adenosine diphosphate (ADP)-induced pathway for platelet aggregation
Absorption
Bioavailability: >50%
Onset: 2 hr
Peak serum time: 0.75 hr
Peak plasma concentration: 3 mg/L
Distribution
Protein bound: 98%
Metabolism
Metabolized in liver by hepatic CYP450 enzymes (in vitro by CYP3A4, CYP2C19 [predominantly], others) to generate active metabolite and also by esterase to generate inactive metabolite
Metabolites: Thiol (active); further activation of thiol metabolite is required through hydrolysis via paraoxonase-1 (PON-1); allele variation of PON-1 may inhibit activation and increase risk for stent thrombosis
Elimination
Half-life: 6 hr (parent drug); 30 min (active metabolite)
Excretion: Urine (50%), feces (46%)
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| clopidogrel oral - | 75 mg tablet |  | |
| clopidogrel oral - | 300 mg tablet |  | |
| clopidogrel oral - | 75 mg tablet |  | |
| clopidogrel oral - | 75 mg tablet |  | |
| clopidogrel oral - | 300 mg tablet |  | |
| clopidogrel oral - | 75 mg tablet |  | |
| clopidogrel oral - | 75 mg tablet | | |
| clopidogrel oral - | 75 mg tablet |  | |
| clopidogrel oral - | 75 mg tablet |  | |
| clopidogrel oral - | 75 mg tablet |  | |
| clopidogrel oral - | 75 mg tablet |  | |
| clopidogrel oral - | 300 mg tablet |  | |
| clopidogrel oral - | 75 mg tablet |  | |
| clopidogrel oral - | 300 mg tablet |  | |
| clopidogrel oral - | 75 mg tablet |  | |
| clopidogrel oral - | 75 mg tablet |  | |
| Plavix oral - | 75 mg tablet |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
clopidogrel oral
CLOPIDOGREL - ORAL
(kloe-PID-oh-grel)
COMMON BRAND NAME(S): Plavix
USES: Clopidogrel is used to prevent heart attacks and strokes in persons with heart disease (recent heart attack), recent stroke, or blood circulation disease (peripheral vascular disease).It is also used with aspirin to treat new/worsening chest pain (new heart attack, unstable angina) and to keep blood vessels open and prevent blood clots after certain procedures (such as cardiac stent).Clopidogrel works by blocking platelets from sticking together and prevents them from forming harmful clots. It is an antiplatelet drug. It helps keep blood flowing smoothly in your body.
HOW TO USE: Read the Medication Guide provided by your pharmacist before you start taking clopidogrel and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth with or without food as directed by your doctor, usually once daily. Take this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day.The dosage and length of treatment are based on your medical condition and response to treatment. If you are taking this medication to prevent clots after a stent implant or other procedure, take this medication with aspirin for many months to years after the procedure (depending on the procedure/type of stent) as directed by your doctor. Consult your doctor for more details and about the risks of stopping early. Keep taking this medication even if you feel well. Do not stop taking this medication without consulting your doctor.Avoid eating grapefruit or drinking grapefruit juice while using this medication unless your doctor or pharmacist says you may do so safely. Grapefruit can increase the chance of side effects with this medicine. Ask your doctor or pharmacist for more details.Get medical help right away if you have any signs that this medication is not working, such as symptoms of a new heart attack or stroke (such as chest/jaw/left arm pain, shortness of breath, unusual sweating, weakness on one side of the body, trouble speaking, sudden vision changes, confusion).
SIDE EFFECTS: Easy bleeding/bruising, stomach upset/pain, diarrhea, and constipation may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Although unlikely, serious bleeding in the stomach, gut, eyes, or brain may occur. Also, clopidogrel can rarely cause a very serious blood disorder (thrombotic thrombocytopenic purpura-TTP). Symptoms may appear any time after starting this medication. Get medical help right away if any of these symptoms occur: severe stomach/abdominal pain, uncontrolled bleeding from gums or nose, bloody/black stools, confusion, fever, extreme skin paleness, purple skin patches, fainting, fast heartbeat, sudden severe headache, unusual weakness/tiredness, vomit with blood or that looks like coffee grounds, trouble speaking, vision changes, seizures, yellowing eyes/skin, bloody/red/pink/dark urine, signs of kidney problems (such as change in the amount of urine).A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before taking clopidogrel, tell your doctor or pharmacist if you are allergic to it; or to similar antiplatelet drugs (thienopyridines such as prasugrel); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: bleeding conditions (such as stomach ulcers, bleeding in the brain/eye), recent surgery, serious injury/trauma, liver disease, bleeding disease (such as hemophilia).To lower the chance of getting cut, bruised, or injured, use caution with sharp objects like razors and nail cutters, and avoid activities such as contact sports.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products). Your doctor may instruct you to stop clopidogrel for at least 5 days before surgery. Do not stop taking clopidogrel without talking with your heart doctor (cardiologist) first.This medicine may cause stomach bleeding. Daily use of alcohol while using this medicine may increase your risk for stomach bleeding. Limit alcoholic beverages. Ask your doctor or pharmacist about how much alcohol you may safely drink.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: See also How to Use section.Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.A product that may interact with this drug is: tipranavir.If you are currently taking aspirin, consult your doctor promptly and ask whether to continue or stop taking it with this medication for your specific condition (aspirin and clopidogrel may be used in combination after a coronary stent procedure, or for some heart conditions). If you are not currently taking aspirin, consult your doctor before starting it for any medical condition.Other medications can affect the removal of clopidogrel from your body, which may affect how clopidogrel works. Examples include certain acid reducers (proton pump inhibitors/PPIs such as omeprazole, esomeprazole), cimetidine, etravirine, felbamate, fluconazole, fluoxetine, fluvoxamine, ketoconazole, rifampin, ticlopidine, voriconazole, among others.Clopidogrel can slow down the removal of other drugs from your body, which may affect how they work. Examples of affected drugs include dasabuvir, repaglinide, among others.Check all prescription and nonprescription medicine labels carefully since many medications contain pain relievers/fever reducers (NSAIDs such as ibuprofen, naproxen, or aspirin). These drugs may increase the risk of bleeding/antiplatelet effect when used with clopidogrel. Ask your pharmacist about using these products safely.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.
NOTES: Do not share this medication with others.Laboratory and/or medical tests (such as complete blood count) may be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.
MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.
STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).
Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
Adding plans allows you to compare formulary status to other drugs in the same class.
To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.
