Select a medication above to begin.
Plavix
clopidogrel
Black Box Warnings .
Diminished Antiplatelet Effect in CYP2C19 Poor Metabolizers
clopidogrel antiplatelet effect is dependent on conversion to active metabolite by CYP450 enzymes, principally CYP2C19; in pts homozygous for nonfunctional alleles of CYP2C19 gene (CYP2C19 poor metabolizers), clopidogrel forms less active metabolite and has reduced anti-platelet activity at recommended doses; CYP2C19 genotype tests are avail. to identify CYP2C19 poor metabolizers; consider using other platelet P2Y12 inhibitor tx in CYP2C19 poor metabolizers
Adult Dosing .
Dosage forms: TAB: 75 mg, 300 mg
acute coronary syndrome
- [75 mg PO qd]
- Start: 300 mg PO x1; Info: give w/ aspirin 75-325 mg PO qd; may use w/ heparin acutely; consider CYP2C19 genotyping; consider holding tx >5 days before surgery
thrombotic event prevention
- [75 mg PO qd]
- Info: for pts w/ recent MI, recent stroke, or peripheral arterial dz; consider CYP2C19 genotyping; consider holding tx >5 days before surgery
renal dosing
- [see below]
- CrCl >60: no adjustment; CrCl <60: not defined, caution advised
- HD/PD: not defined
hepatic dosing
- [no adjustment]
Peds Dosing .
- Dosage forms: TAB: 75 mg, 300 mg
TIA/thromboembolic stroke prevention (off-label)
- [<2 yo]
- Dose: 0.2 mg/kg/dose PO qd; Max: 75 mg/day; Info: refer to ACCP guidelines or institution protocols for details on appropriate use
- [2 yo and older]
- Dose: 1 mg/kg/dose PO qd; Max: 75 mg/day; Info: refer to ACCP guidelines or institution protocols for details on appropriate use
renal dosing
- [not defined]
- renal impairment: consider adult renal dosing for guidance
- HD/PD: not defined
hepatic dosing
- [not defined]
- hepatic impairment: consider adult hepatic dosing for guidance
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- bleeding, active
- poor CYP2C19 metabolizers
- caution: intermediate CYP2C19 metabolizers
- caution: CrCl <60
- caution: trauma
- caution: elective surgery w/in 5 days
- caution: GI disorder
- caution: ocular dz
Drug Interactions .
Overview
clopidogrel
antiplatelet
- CYP2C19 substrate
- CYP3A4 substrate
- CYP2B6 inhibitor, weak
- CYP2C8 inhibitor, moderate
- CYP2C19 inhibitor, weak
- carboxylesterase 1 inhibitor
- OATP1B1 inhibitor, weak
- affected by altered gastrointestinal motility
- antiplatelet
Contraindicated
- abrocitinib
- grazoprevir
Avoid/Use Alternative
- alfentanil
- apalutamide
- atazanavir
- brincidofovir
- buprenorphine
- butorphanol
- cangrelor
- cannabidiol
- cannabis
- caplacizumab
- cenobamate
- cobicistat
- codeine
- danshen
- darunavir
- dihydrocodeine
- efavirenz
- elagolix
- enoxaparin
- esomeprazole
- etrasimod
- etravirine
- fedratinib
- fentanyl
- fexinidazole
- fluconazole
- fluoxetine
- fluvoxamine
- fondaparinux
- hydrocodone
- hydromorphone
- ibritumomab tiuxetan
- levorphanol
- meperidine
- methadone
- morphine
- nalbuphine
- oliceridine
- omacetaxine mepesuccinate
- omeprazole
- oseltamivir
- oxycodone
- oxymorphone
- pentazocine
- rabeprazole
- remifentanil
- repaglinide
- rifampin
- ritonavir
- St. John's wort
- stiripentol
- sufentanil
- tapentadol
- tramadol
- vonoprazan
- voriconazole
Monitor/Modify Tx
- acalabrutinib
- ado-trastuzumab emtansine
- aducanumab
- afatinib
- alteplase
- amiodarone
- anacaulase
- anagrelide
- antithrombin
- apixaban
- argatroban
- asparaginase
- aspirin
- atogepant
- atorvastatin
- avapritinib
- axitinib
- bevacizumab
- binimetinib
- bivalirudin
- bromelain
- bromfenac ophthalmic
- bupropion
- cabazitaxel
- cabozantinib
- calaspargase
- carfilzomib
- celecoxib
- cilostazol
- citalopram
- collagenase clostridium histolyticum
- dabigatran
- dalteparin
- daprodustat
- dasabuvir
- dasatinib
- deferasirox
- defibrotide
- desvenlafaxine
- diazepam
- diclofenac
- diclofenac ophthalmic
- diclofenac topical
- diflunisal
- dimethyl fumarate
- diosmin
- dipyridamole
- diroximel fumarate
- duloxetine
- edoxaban
- eltrombopag
- eluxadoline
- encorafenib
- epoprostenol
- eptifibatide
- erlotinib
- escitalopram
- ethanol
- etodolac
- evening primrose oil
- fenoprofen
- fenugreek
- flibanserin
- flurbiprofen
- flurbiprofen ophthalmic
- fosphenytoin
- fruquintinib
- garlic
- gefitinib
- gemtuzumab ozogamicin
- ginkgo
- heparin
- hydrocortisone
- ibrutinib
- ibuprofen
- ibuprofen lysine
- icosapent ethyl
- iloprost inhaled
- imatinib
- indomethacin
- inotersen
- ketoprofen
- ketorolac
- ketorolac ophthalmic
- krill oil
- lecanemab
- lenvatinib
- levomilnacipran
- lifileucel
- lovastatin
- magnesium salicylate
- mavacamten
- meclofenamate
- mefenamic acid
- meloxicam
- methotrexate
- methyl salicylate topical
- milnacipran
- mitotane
- momelotinib
- monomethyl fumarate
- nabumetone
- naproxen
- nateglinide
- nattokinase
- nepafenac ophthalmic
- niacin (vitamin B3)
- nilotinib
- nintedanib
- nusinersen
- omega-3-acid
- oxaprozin
- ozanimod
- paclitaxel
- pacritinib
- paroxetine
- pazopanib
- pegaspargase
- penicillin G
- pentosan polysulfate sodium
- pentoxifylline
- phenytoin
- pioglitazone
- piperacillin
- piroxicam
- pirtobrutinib
- pitavastatin
- plasminogen, human
- ponatinib
- porfimer
- pralsetinib
- prasugrel
- pravastatin
- ramucirumab
- ranibizumab
- red yeast rice
- regorafenib
- resmetirom
- reteplase
- rivaroxaban
- rosiglitazone
- rosuvastatin
- salsalate
- saw palmetto
- selexipag
- selpercatinib
- selumetinib
- sertraline
- sirolimus albumin-bound
- sodium zirconium cyclosilicate
- sorafenib
- sotatercept
- sugammadex
- sulindac
- sunitinib
- tenecteplase
- tipranavir
- tirofiban
- tisotumab vedotin
- tivozanib
- tolmetin
- trametinib
- trazodone
- treprostinil
- upadacitinib
- valproic acid
- vandetanib
- venlafaxine
- vilazodone
- vinpocetine
- vorapaxar
- vortioxetine
- warfarin
- willow bark
- zanubrutinib
- ziv-aflibercept
Caution Advised
- armodafinil
- bosentan
- carisoprodol
- ceritinib
- chloramphenicol
- cimetidine
- cyclophosphamide
- dicloxacillin
- enasidenib
- enzalutamide
- eslicarbazepine acetate
- estradiol (contraceptive)
- ethinyl estradiol (contraceptive)
- felbamate
- givosiran
- glecaprevir
- ifosfamide
- isoniazid
- ketoconazole
- levoketoconazole
- lonafarnib
- luliconazole topical
- modafinil
- osilodrostat
- oxcarbazepine
- proguanil
- rucaparib
- tecovirimat
- topiramate
- triclabendazole
- tucatinib
- verteporfin
- voxilaprevir
Adverse Reactions .
Serious Reactions
- bleeding, severe
- hemorrhage
- TTP
- agranulocytosis
- aplastic anemia
- pancytopenia
- hypersensitivity rxn
- anaphylactoid rxn
- exfoliative dermatitis
- Stevens-Johnson syndrome
- toxic epidermal necrolysis
- erythema multiforme
- drug rxn w/ eosinophilia and systemic sx
- acute generalized exanthematous pustulosis
- pneumonia, eosinophilic
Common Reactions
- bleeding
- pruritus
Safety/Monitoring .
Monitoring Parameters
no routine tests recommended
Look/Sound-Alike Drug Names
Plavix confused with: Elavil; Mavik; Paxil; Plendil; Pletal; Pradaxa; Protonix
Pregnancy/Lactation .
Pregnancy
Clinical Summary
benefits outweigh risks during pregnancy; consider D/C clopidogrel 5-7 days before labor, delivery, or neuraxial blockade; risk of fetal harm not expected based on limited human data; no known risk of fetal harm based on animal data at 65x and 78x recommended human dose; risk of maternal hemorrhage based on drug's mechanism of action
Lactation
Clinical Summary
weigh risk/benefit while breastfeeding; low risk of infant harm based on limited human data and drug properties; no human data available to assess effects on milk production
Pharmacology .
Metabolism: liver; CYP450: 1A2, 2C9, 2C19 (primary), 3A4 substrate; Info: prodrug converted to active thiol metabolite
Excretion: urine 50%, feces 46%; Half-life: 6h (parent drug), 30min (active metabolite)
Subclass: Antiplatelets, Cardiovascular ; Stroke
Mechanism of Action
irreversibly binds to P2Y12 adenosine diphosphate receptors, reducing platelet activation and aggregation
Formulary .
No Formulary Selected
Join Now to View Patient Handouts!
Create a FREE epocrates Online account to access patient medication instructions. Your patients and caregivers will appreciate you printing these friendly handouts, available in English and Spanish. Each handout addresses common concerns such as how to take the medication, and possible side effects.
Current Members: Sign In.
Pill Pictures
Join Now to View Pill Pictures!
Create a FREE epocrates Online account to access full-color images of medications within the drug monograph.
Current Members: Sign In.