Plavix: Advanced Antiplatelet Protection for Cardiovascular Health
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Synonyms
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Plavix (clopidogrel bisulfate) is a prescription antiplatelet medication specifically designed to reduce the risk of thrombotic events in patients with acute coronary syndrome, recent myocardial infarction, recent stroke, or established peripheral arterial disease. As a potent P2Y12 adenosine diphosphate (ADP) receptor inhibitor, it works by selectively and irreversibly blocking platelet activation and aggregation, a key mechanism in arterial thrombosis formation. Its targeted action makes it a cornerstone in modern cardiology for secondary prevention of atherothrombotic events, offering a well-established safety and efficacy profile backed by extensive clinical research and real-world use across diverse patient populations.
Features
- Active ingredient: Clopidogrel bisulfate
- Available in 75 mg and 300 mg oral tablets
- Prodrug requiring hepatic cytochrome P450 metabolism for activation
- Irreversible binding to P2Y12 ADP receptors on platelets
- Once-daily dosing regimen for maintenance therapy
- Bioavailability approximately 50% after oral administration
- Peak plasma concentration achieved within approximately 45 minutes
- Generic versions available alongside brand-name formulation
Benefits
- Significantly reduces risk of myocardial infarction, stroke, and cardiovascular death
- Provides reliable platelet inhibition for up to 7-10 days after discontinuation
- Demonstrated efficacy in both acute and long-term cardiovascular protection
- Well-tolerated profile with extensive clinical experience spanning decades
- Compatible with various cardiovascular medications in combination therapy
- Reduces need for urgent revascularization procedures in high-risk patients
Common use
Plavix is primarily indicated for the reduction of atherothrombotic events in patients with recent acute coronary syndrome (unstable angina, non-Q-wave myocardial infarction), including those who have been managed medically or with percutaneous coronary intervention (with or without stent placement). It is also approved for use in patients with history of recent myocardial infarction, recent ischemic stroke, or established peripheral arterial disease. The medication is frequently prescribed in combination with aspirin (dual antiplatelet therapy) following coronary stent implantation to prevent stent thrombosis, with duration of therapy dependent on stent type and patient risk factors. Off-label uses may include certain thrombophilic conditions and secondary prevention in other arterial bed diseases, though these applications require careful individual risk-benefit assessment.
Dosage and direction
The standard maintenance dose of Plavix is 75 mg once daily, with or without food. For patients with acute coronary syndrome, a loading dose of 300 mg is typically administered initially, followed by 75 mg daily. Some clinical scenarios may warrant a 600 mg loading dose for more rapid platelet inhibition, particularly in patients undergoing urgent percutaneous coronary intervention. The medication should be taken at approximately the same time each day to maintain consistent platelet inhibition. Duration of therapy varies from months to years depending on the clinical indication, with current guidelines recommending at least 6-12 months of dual antiplatelet therapy after drug-eluting stent implantation, and sometimes longer in high-risk patients. Patients should not crush or chew tablets; they should be swallowed whole with a glass of water.
Precautions
Patients should be carefully evaluated for bleeding risk before initiating therapy, including assessment of concomitant medications that might increase bleeding risk. Regular monitoring of complete blood count is recommended, particularly during the first weeks of treatment. Caution is advised in patients who may require urgent coronary artery bypass graft surgery, as antiplatelet effect may increase surgical bleeding risk. Patients should be instructed to report any unusual bleeding or bruising promptly. Those with genetic polymorphisms of CYP2C19 may have reduced platelet inhibition and require alternative therapy. Dental procedures and other interventions should be planned carefully, with healthcare providers informed of Plavix use. The medication should be used cautiously in patients with severe hepatic impairment, as metabolism may be affected.
Contraindications
Plavix is contraindicated in patients with active pathological bleeding such as peptic ulcer or intracranial hemorrhage. It must not be used in patients with hypersensitivity to clopidogrel or any component of the formulation. The medication is contraindicated in patients with severe liver impairment, as the metabolic activation process may be compromised. Concomitant use with strong CYP2C19 inhibitors that may prevent conversion to active metabolite should be avoided. It is not recommended during pregnancy unless clearly needed, and generally avoided in breastfeeding women due to potential risk to infant.
Possible side effect
Common adverse effects include bleeding manifestations such as bruising (15-20%), epistaxis (5%), and gastrointestinal bleeding (2%). Less frequent side effects may include diarrhea (4%), rash (3%), pruritus (3%), and hematological abnormalities including thrombotic thrombocytopenic purpura (rare). Serious but rare side effects include severe neutropenia (<0.04%), aplastic anemia, and hepatitis. Some patients may experience headache (6%), dizziness (4%), or depression (3%). Gastrointestinal effects such as abdominal pain (6%), dyspepsia (5%), and nausea (4%) have been reported. Most bleeding events are mild to moderate in severity, though serious bleeding requiring transfusion occurs in approximately 1-2% of patients annually.
Drug interaction
Plavix demonstrates significant interactions with medications affecting CYP2C19 metabolism, including omeprazole and esomeprazole (reducing antiplatelet effect). Concurrent use with warfarin, heparin, or other anticoagulants significantly increases bleeding risk. NSAIDs including ibuprofen and naproxen may enhance gastrointestinal bleeding risk. Strong CYP3A4 inhibitors (ketoconazole, itraconazole) may affect metabolism. Caution is advised with selective serotonin reuptake inhibitors due to potential increased bleeding risk. The combination with aspirin produces synergistic antiplatelet effects but increases bleeding risk proportionally. Proton pump inhibitors not affecting CYP2C19 (such as pantoprazole) may be preferred when gastric protection is needed.
Missed dose
If a dose is missed, the patient should take it as soon as remembered unless it is almost time for the next scheduled dose. In that case, the missed dose should be skipped and the regular dosing schedule resumed. Patients should never take a double dose to make up for a missed one, as this may increase bleeding risk. Consistency in dosing is important for maintaining stable platelet inhibition, so patients should be counseled on adherence strategies. If multiple doses are missed, healthcare provider consultation is recommended as protection against thrombotic events may be reduced.
Overdose
Plavix overdose may lead to bleeding complications ranging from minor bleeding to life-threatening hemorrhage. Management is primarily supportive, as there is no specific antidote. Platelet transfusion may be considered in cases of serious bleeding, though transfused platelets may also be affected by circulating active metabolite. Gastric lavage may be considered if ingestion was recent. Activated charcoal can be administered if within 1-2 hours of ingestion. Monitoring of coagulation parameters and complete blood count is essential. Bleeding time may be prolonged, and surgical hemostasis may be challenging. Dialysis is unlikely to be effective due to high protein binding.
Storage
Store at room temperature (15-30°C or 59-86°F) in the original container with the lid tightly closed. Protect from moisture and light. Keep out of reach of children and pets. Do not store in bathroom cabinets where humidity levels may fluctuate. Do not use if tablets appear discolored or show signs of moisture damage. Proper disposal of unused medication is important; consult pharmacy for take-back programs rather than flushing down toilet or throwing in household trash.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Individual patient needs may vary, and healthcare provider consultation is essential before starting or modifying any treatment regimen. The prescribing information provided here may not include all possible uses, directions, precautions, or interactions. Always follow the guidance of qualified healthcare professionals and refer to the official prescribing information for complete details. Actual clinical decisions should be based on individual patient characteristics and current medical evidence.
Reviews
Clinical trials demonstrate consistent efficacy in reducing cardiovascular events, with the CAPRIE trial showing overall risk reduction of 8.7% compared to aspirin. The CURE trial demonstrated 20% relative risk reduction in cardiovascular death, MI, or stroke with clopidogrel plus aspirin versus aspirin alone in ACS patients. Real-world evidence supports maintained effectiveness across diverse populations, though response variability exists. Most cardiologists report favorable experience with predictable antiplatelet effect and manageable safety profile. Patient satisfaction surveys indicate general acceptance of therapy, with bleeding concerns being the most common reason for discontinuation. Long-term follow-up data confirm sustained benefit in appropriate patient populations.