Clopidogrel
Brand: Plavix (US/EU) / Clopitab (IN) / Clopivas (IN) / Clopid (BD)
Antiplatelet
P2Y12 inhibitor (thienopyridine, prodrug)
Pharmacokinetics
| Half-life | 8 hours |
| Tmax | 1 h |
| Protein Binding | 98 % |
| Volume of Distribution | 0.2 L/kg (approx) |
| Clearance Route | hepatic |
| Active Metabolites | yes |
| Notes | Prodrug requiring CYP2C19 activation; reduced effect in poor metabolizers; consider alternative (ticagrelor/prasugrel) in loss-of-function alleles. | Updated 2025: CPIC and AHA guidelines recommend CYP2C19 genotyping before initiation. Poor metabolizers show reduced antiplatelet efficacy; consider prasugrel or ticagrelor instead. Avoid strong CYP2C19 inhibitors (omeprazole, esomeprazole). Reference: https://cpicpgx.org/guidelines/guideline-for-clopidogrel-and-cyp2c19/ |
⚠️ Safety & Warnings
Severity: Moderate
Adverse Effects:
Bleeding (GI/intracranial), dyspepsia, rash; RARE: thrombotic thrombocytopenic purpura (TTP), neutropenia
Contraindications:
Active pathological bleeding (e.g., intracranial hemorrhage, GI bleed), severe hepatic impairment, known hypersensitivity
Precautions:
Consider **Clopidogrel resistance test (CYP2C19)** in high-risk PCI or suspected poor response; avoid strong CYP2C19 inhibitors (e.g., omeprazole) if possible; stop 5–7 days before major surgery; use caution with concomitant anticoagulants/NSAIDs