Plavix is a medication contains an active ingredient called Clopidogrel which is an antiplatelet. It functions by inhibiting the binding of adenosine diphosphate (ADP) to its platelet receptor, which resulted in the inhibition of platelet aggregation.
Although this medication is widely used in a patient with heart disease such as stroke, peripheral artery disease and also acute coronary syndrome, there are few situations where it shouldn’t be given to the patient even if it was indicated due to the above conditions.
Since this medication is a blood thinner, it is absolutely dangerous to be given to a patient with active bleeding or with a bleeding tendency. Patients with gastrointestinal or intracranial bleed shouldn’t be administered with this medication. Since this medication will be metabolized and excreted by the liver and kidney respectively, it is advised to use with caution in a patient with hepatic and renal impairment.
Other than medical conditions, another consideration that has to be taken before giving Plavix to a patient is medication history. There are few medications that are contraindicated with Plavix where they can either increase the effects which causing larger side effects or causing it to be inactive.
Even though aspirin can be given in combination with clopidogrel, bleeding risk should be asses and monitored throughout the course of medication as bleeding risk is increased with coadministration of these two medications.
- Opioids
Administration of opioids with Plavix can reduce it’s absorption, therefore, it will directly reduce the desired effects of administration of this compound which is to inhibit aggregation of the platelet.
- Platelet glycoprotein IIb/IIa inhibitors
Giving both Plavix (clopidogrel) together with platelet glycoprotein IIb/IIa inhibitors like Abciximab will further increase the risk of bleeding.
- Calcium channel blocker
Desired effects of administring Plavix can be reduced with coadministration with calcium channel blockers such as amlodipine as it can reduce clopidogrel’s conversion to its active metabolites.
- Proton pump inhibitor (PPI)
In the case of a patient requires taking a proton pump inhibitor while taking Plavix, consider using the PPI with fewer effects on antiplatelet activity. This is because of PPI like Omeprazole can reduce the conversion of clopidogrel to its active metabolites thus reducing it’s desired effects as an antiplatelet agent.
- Other platelets inhibitors
It is not advised to use clopidogrel with other platelet inhibitors like apixaban and argatroban as they will increase the risk of bleeding.
- Thrombocytopenic drugs
Any drugs that have thrombocytopenic properties shouldn’t be administered together with Plavix to avoid the high risk of bleeding. For example antineoplastic drugs such as Altretamine, Bevacizumab, and Chlorambucil.
- Selective Seratonin Re-uptake Inhibitor (SSRI): Anti-depressant
SSRI like Fluoxetine can reduce the conversion of clopidogrel into its active metabolites thus reducing its effect. It is also known to affect platelet activation, therefore can increase the risk of bleeding in co-administration of these medications. Consider close monitoring or try other anti-depressants with the patient that is taking Plavix.
- Pioglitazone
Administration Clopidogrel together with Pioglitazone a diabetic medication can increase the concentration of Pioglitazone. Therefore adjustment to the dosage of Pioglitazone is required in the patient that is taking Plavix.
Read more about Plavix administration and dosage by DoctorOnCall on their website.