Indications for: PLAVIX
To reduce the rate of MI and stroke in patients with: non-ST-segment elevation acute coronary syndrome (unstable angina/non-ST-elevation MI) or acute ST-elevation MI; history of recent MI, recent stroke, or established peripheral arterial disease; see full labeling.
Acute coronary syndrome (give with aspirin): initially give one 300mg loading dose, then continue at 75mg once daily. Recent MI, recent stroke, or established peripheral arterial disease: 75mg once daily without a loading dose.
Active pathologic bleeding (eg, peptic ulcer, intracranial hemorrhage).
Diminished antiplatelet effect in patients with two loss-of-function alleles of the CYP2C19 gene.
CYP2C19 poor metabolizers: diminished effectiveness in those who are homozygous for nonfunctional alleles of the CYP2C19 gene. Perform testing for the CYP2C19 genotype before starting therapy; consider alternative treatment if identified. Increased risk of bleeding. Premature discontinuation increases risk of cardiovascular events; if temporarily discontinued (eg, to treat bleeding or surgery; if possible, interrupt therapy for 5 days before such surgery); restart as soon as possible. Moderate and severe renal impairment. Pregnancy. Labor & delivery: discontinue 5–7 days prior to labor, delivery, or neuraxial blockade. Nursing mothers.
P2Y12 platelet inhibitor (thienopyridine).
Avoid concomitant CYP2C19 inhibitors (eg, omeprazole, esomeprazole) or strong CYP2C19 inducers (eg, rifampin). Antagonized by opioid agonists (eg, morphine, others); consider using IV anti-platelet agent instead. Caution with concomitant other drugs that increase risk of bleeding (eg, NSAIDs, warfarin, SSRIs, SNRIs, other antiplatelet agents); evaluate for blood loss if concomitant with other antiplatelets. Avoid concomitant repaglinide; if unavoidable, initiate repaglinide at 0.5mg before each meal; max 4mg/day; monitor glucose frequently.
Bleeding (may be fatal), epistaxis, hematuria, bruising, ulcers, rash; hypersensitivity reactions, thrombotic thrombocytopenic purpura.
Generic Drug Availability:
Tabs 75mg—90; 300mg—30