Clopidogrel

Clopidogrel is a antiplatelet agent (p2y12 inhibitor) medicine available in Bangladesh under many brand names. Below are its uses, dosage, side effects and precautions — and all brands with their current prices.

• After a heart attack (myocardial infarction) — to prevent another attack
• After coronary stent placement (PCI/ring) — to stop clots forming inside the stent, usually with aspirin
• Acute coronary syndrome — unstable angina or heart attack, with aspirin
• After ischaemic stroke or mini-stroke (TIA) — to prevent another stroke
• Peripheral arterial disease — blocked leg arteries causing pain on walking

Your doctor or cardiologist will decide the dose and duration of Clopidogrel based on your condition — for example, after a stent you may need it together with aspirin for a fixed period decided by the cardiologist.

• Take it once daily, at about the same time, with or without food.
• If you miss a dose, take it as soon as you remember the same day; if it is almost time for the next dose, skip the missed one — never double up.
• Do not change the dose yourself.

Never stop Clopidogrel on your own — stopping suddenly, especially after a stent, can cause the stent to block and trigger a heart attack. Never stop it before any operation or dental procedure without asking the doctor who prescribed it.

Because clopidogrel reduces clotting, bleeding-related effects are the most common:

• Bruising more easily, longer bleeding from cuts
• Nosebleeds, bleeding gums
• Stomach upset, diarrhoea, abdominal pain
• Rash or itching

Seek urgent medical help if you notice:

• Black or tarry stools, blood in vomit (may look like coffee grounds), blood in urine
• Unusual or prolonged bleeding that will not stop
• Sudden weakness, severe headache or confusion
• Unexplained fever, extreme tiredness, purple skin spots or yellowing of eyes (very rare blood disorder TTP)

• Tell every doctor, dentist or surgeon that you take Clopidogrel before any procedure, surgery or tooth extraction — it is usually stopped 5–7 days beforehand, but only on the prescribing doctor's instruction.
• Tell your doctor if you have a stomach ulcer, previous bleeding, liver disease or a planned operation.
• Use a soft toothbrush and shave carefully to reduce bleeding.
• Avoid contact sports or activities with high injury risk.
• Do not take regular painkillers like ibuprofen or diclofenac without asking — they increase bleeding risk.
• Some people genetically respond less to clopidogrel; if a clot occurs despite the medicine, your doctor may switch to an alternative.

• Omeprazole and esomeprazole (PPIs): can reduce the activation and effect of clopidogrel — doctors usually prefer pantoprazole or rabeprazole if a gastric medicine is needed
• NSAID painkillers (ibuprofen, diclofenac, naproxen) and aspirin: higher bleeding risk; aspirin is combined only when the doctor prescribes it deliberately
• Anticoagulants (warfarin, rivaroxaban, heparin): major bleeding risk — combined only under specialist supervision
• SSRIs (escitalopram, sertraline): can add to bleeding tendency
• Strong CYP2C19 inhibitors (fluconazole, fluoxetine): may blunt clopidogrel's effect

Tell your doctor about all medicines, supplements and herbal products you use.

• Allergy to clopidogrel or any component of the medicine
• Active bleeding — such as a bleeding stomach ulcer or bleeding inside the brain
• Severe liver disease
• It should not be started without medical assessment in people with recent major trauma or surgery

Pregnancy: Clopidogrel is used in pregnancy only if clearly needed. Animal studies have not shown harm, but human data are limited, and the bleeding risk around delivery needs careful planning. Always tell your doctor if you are pregnant or planning pregnancy so the risks and benefits can be weighed.

Lactation: It is not known whether clopidogrel passes into human breast milk. Breastfeeding is generally not recommended during treatment — discuss with your doctor whether to stop the medicine or stop breastfeeding based on how essential the drug is for you.

Store below 30°C in a cool, dry place away from direct sunlight and moisture. Keep in the original blister pack until use, and keep out of the reach of children. Do not use after the expiry date.