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Clopidogrel

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VOL: 101, ISSUE: 49, PAGE NO: 33

GENERIC AND PROPRIETARY NAMES

- Clopidogrel.

- Plavix.

ACTION

- Inhibits the first and second phase of ADP-induced effects in platelet aggregation.

CLASSIFICATION

- Antiplatelet drugs.

INDICATIONS

- Prevention of ischaemic events in symptomatic ischaemic disease.

- In combination with low-dose aspirin in acute coronary syndrome without ST elevation.

CONTRAINDICATIONS

- Active bleeding.

- Breastfeeding.

CAUTIONS

- Avoid in first few days post-myocardial infarction and for seven days post-stroke.

- Increased risk of bleeding.

- Liver or renal impairment.

- Pregnancy.

COMMON SIDE-EFFECTS

- Dyspepsia.

- Gastrointestinal problems.

- Bleeding disorders.

- Headache.

- Dizziness.

- Paraesthesia.

- Leucopenia.

RARE SIDE-EFFECTS

- Colitis.

- Pancreatitis.

- Hepatitis.

- Vasculitis.

- Confusion.

- Hallucinations.

- Taste disturbance.

- Blood disorders.

- Hypersensitivity-like reactions.

INTERACTIONS

- Increased bleeding tendency with anticoagulants, aspirin, nonsteroidal anti-inflammatory medication, coumarins, phenindione dipyridamole and iloprost.

ADMINISTRATION

- Oral.

- Administer with food to reduce gastric symptoms.

NURSING CONSIDERATIONS

- Discontinue medication seven days before elective surgery if antiplatelet effect is not desirable.

- The combination of low-dose aspirin and clopidogrel in acute coronary syndrome without ST elevation is given for at least one month but no longer than 9-12 months. The routine long-term use of this combination increases the risk of bleeding without clear evidence of benefits.

PATIENT TEACHING

- Ensure that patients are aware of the importance of informing health care professionals, including doctors and dentists, that they are taking clopidogrel before starting any other treatment.

- Advise patients that excessive intake of alcohol should be avoided with this medication.

- Ensure that patients know they should report any signs of increased bleeding and bruising.

- Nurses should refer to manufacturer’s summary of product characteristics and to appropriate local guidelines

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