Index of drugs

Antithrombotic prophylaxis in symptomatic atherosclerosis: in adult patients with myocardial infarction (from several days to less than 35 days), with ischemic stroke (from 7 days to less than 6 months) and with diagnosed peripheral artery disease; in adult patients with non-ST segment elevation acute coronary syndrome (unstable angina or non-Q-wave myocardial infarction), including patients who receive a stent during percutaneous coronary intervention in combination with Acetylsalicylic acid or acute myocardial infarction with ST elevation, in combination with Acetylsalicylic acid, in patients who are conservatively treated, eligible for thrombolytic therapy.

1 tabl powl. contains 75 mg of clopidogrel; drug contains lactose, castor oil and butylated hydroxyanisole.

Platelet aggregation inhibitor. Clopidogrel is a prodrug and one of its active metabolites inhibits platelet aggregation. The active metabolite of clopidogrel selectively inhibits the binding of ADP to its platelet receptor and further activation of ADP-mediated GP IIb / IIIa complex, leading to inhibition of platelet aggregation. It also inhibits platelet aggregation induced by other agonists, blocking the potentiation of platelet activation by the released ADP. It works by irreversibly modifying the platelet ADP receptor. Repeated doses of 75 mg daily cause a significant inhibition of ADP-induced platelet aggregation, which gradually increases and reaches a state of equilibrium between Day 3 and Day 7. At steady-state, the mean inhibition level observed at 75 mg / day was 40- 60%. Platelet aggregation and bleeding time gradually return to baseline, usually within 5 days after discontinuation of treatment. Clopidogrel is rapidly absorbed from the digestive tract. About 50% of the dose is absorbed. It is extensively metabolised in the liver. Metabolism takes place through two major metabolic pathways. In the first part, esterases take part by hydrolysing clopidogrel to an inactive carboxylic acid derivative (constituting 85% of circulating metabolites); the second is mediated by numerous cytochrome P450 isoenzymes: initially, clopidogrel is metabolized to the intermediate (2-oxoclopidogrel) metabolite, which is then converted into the active metabolite, a thiol derivative. This process is regulated by the CYP3A4, CYP2C19, CYP1A2 and CYP2B6 isoenzymes. The active thiol metabolite binds rapidly and irreversibly to platelet receptors, inhibiting their aggregation. About 50% of the drug is excreted in the urine and about 46% in the faeces. T_0,5 clopidogrel is 6 hours.

Hypersensitivity to clopidogrel or other components of the preparation. Severe hepatic impairment. Active pathological bleeding (eg, bleeding from peptic ulcer or intracranial haemorrhage).

Patients should be carefully monitored for any signs of bleeding, including occult bleeding, especially during the first weeks of treatment or after invasive cardiac procedures or other surgical procedures. Because of the risk of bleeding and haematological adverse reactions, blood counts should be immediately considered and / or other appropriate tests should be considered for clinical signs suggestive of bleeding during treatment. Caution should be exercised in patients who may be at greater risk of major bleeding due to injury, surgery or other pathological conditions, in patients with bleeding episodes (especially gastrointestinal and intraocular) and patients receiving acetylsalicylic acid, medicines with NSAID groups, Heparin or glycoprotein IIb / IIIa inhibitors. Co-administration of clopidogrel with oral anticoagulants is not recommended. Use with caution in patients with impaired renal function or with moderate hepatic disease. If the patient is to undergo elective surgery and the antiplatelet effect is temporarily undesirable, clopidogrel should be discontinued 7 days before the procedure.Clopidogrel is not recommended for the first 7 days after acute ischemic stroke. CYP2C19 inhibitors (including all proton pump inhibitors) are not recommended at the same time as Clopidogrel, as this combination therapy may reduce the concentration of the active metabolite of clopidogrel. Patients with genetically determined poor CYP2C19 activity have lower exposure to the active metabolite of clopidogrel, weaker inhibition of platelet aggregation and, as a rule, higher incidence of cardiovascular events after myocardial infarction - no optimal dosage of clopidogrel has been found in poor metabolisers. The safety and efficacy of clopidogrel in children and adolescents has not been established. Due to the lactose content, the preparation should not be used in patients with hereditary galactose intolerance, Lapp lactase deficiency or malabsorption of glucose-galactose. Due to the content of castor oil, the drug may cause indigestion and diarrhea.

The use of the drug during pregnancy is not recommended. You should not breast-feed during treatment with clopidogrel.

Common: hematoma, nosebleed, bleeding at the injection site, bruise, gastrointestinal bleeding, diarrhea, abdominal pain, indigestion. Uncommon: thrombocytopenia, leukopenia, eosinophilia, intracranial bleeding (sometimes with fatal outcome), headache and dizziness, paresthesia, eye bleeding (conjunctival, intraocular, retinal), stomach and duodenal ulcer, gastritis, vomiting, nausea, constipation, flatulence, rash, pruritus, purpura, hematuria, prolonged bleeding time, decreased neutrophil count, decreased platelet count. Rare: neutropenia (including severe), vertigo, retroperitoneal hemorrhage. Very rare: thrombotic thrombocytopenic purpura (TTP), aplastic anemia, pancytopenia, agranulocytosis, severe thrombocytopenia, granulocytopenia, anemia, serum sickness, anaphylactoid reactions, hallucinations, confusion, taste disturbances, severe hemorrhage, surgical haemorrhage, vasculitis, hypotension, bleeding from the airways (haemoptysis, pulmonary haemorrhage), bronchospasm, interstitial pneumonitis, gastrointestinal and post-mortem haemorrhage, pancreatitis, colitis (also ulcerative or lymphocytic), oral mucositis, acute hepatic failure, hepatitis, abnormal liver function tests, bullous dermatitis (toxic epidermal necrolysis, Stevens-Johnson syndrome, erythema multiforme), angioneurotic edema, erythematous rash, urticaria, eczema, lichen planus, muscular bleeding eletronic (intraarticular), inflammation and pain in the joints, muscle pain, glomerulonephritis, increase in blood creatinine, fever.

Orally. Adults and the elderly: 75 mg once a day, regardless of meals.Patients with acute coronary syndrome without ST segment elevation (unstable angina or non-Q-wave myocardial infarction): clopidogrel should be started with a single 300 mg loading dose and then continued with 75 mg once a day (in combination with acetylsalicylic acid 75-325 mg daily). Because higher doses of acetylsalicylic acid have been associated with a greater risk of bleeding, it is recommended that the dose of acetylsalicylic acid should not exceed 100 mg daily. The optimal treatment period has not been clearly established. Data from clinical trials confirm the use up to 12 months, and the maximum effect was observed after 3 months.Patients with acute coronary syndrome with acute myocardial infarction with ST elevation: Clopidogrel should be started with a loading dose of 300 mg and then given 75 mg once a day in combination with acetylsalicylic acid and with or without thrombolytics. In patients over 75 years of age, clopidogrel should be started without a loading dose. Combination therapy should be started as soon as possible after the onset of symptoms and continued for at least 4 weeks. The benefit of concomitant administration of clopidogrel and acetylsalicylic acid over 4 weeks in this treatment regimen has not been studied.