Plavix: Advanced Antiplatelet Protection for Cardiovascular Health
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Synonyms
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Plavix (clopidogrel bisulfate) is a prescription antiplatelet medication specifically designed to reduce the risk of heart attack and stroke in patients with recent myocardial infarction, recent stroke, or established peripheral arterial disease. It functions by inhibiting platelet aggregation, a key mechanism in the formation of arterial blood clots that can lead to acute cardiovascular events. As a cornerstone in modern cardiology and vascular medicine, Plavix represents a critical therapeutic option for long-term management of atherothrombotic conditions, offering targeted protection with a well-established efficacy and safety profile supported by extensive clinical research and real-world application across diverse patient populations.
Features
- Contains clopidogrel bisulfate as the active pharmaceutical ingredient
- Available in 75 mg and 300 mg oral tablet formulations
- Prodrug requiring hepatic activation via cytochrome P450 enzymes (primarily CYP2C19)
- Irreversible inhibition of the P2Y12 component of ADP receptors on platelets
- Standardized manufacturing under current Good Manufacturing Practices (cGMP)
- Bioequivalence maintained across production batches
- Child-resistant packaging compliant with international safety standards
- Temperature-stable formulation requiring no special handling
- Clearly marked tablet identification for dose verification
- Prescription-only status ensuring medical supervision
Benefits
- Significantly reduces incidence of subsequent myocardial infarction in patients with acute coronary syndrome
- Lowers risk of ischemic stroke in patients with cerebrovascular disease
- Decreases thrombotic complications following percutaneous coronary intervention (PCI) with stent placement
- Provides sustained antiplatelet protection with once-daily dosing convenience
- Demonstrates proven efficacy in combination therapy with aspirin (dual antiplatelet therapy)
- Offers cost-effective long-term management compared to alternative interventions
Common use
Plavix is primarily indicated for the reduction of atherosclerotic events in patients with established cardiovascular disease. Its most frequent applications include secondary prevention following acute coronary syndrome (unstable angina, non-ST-elevation myocardial infarction, or ST-elevation myocardial infarction), particularly when managed with percutaneous coronary intervention and stent placement. Additionally, it is prescribed for patients with history of recent ischemic stroke (from 7 days to less than 6 months) or established peripheral arterial disease. The medication is often used in combination with low-dose aspirin (dual antiplatelet therapy or DAPT) for specified durations depending on stent type and patient risk factors, with treatment duration typically ranging from 1 month to 1 year or longer based on individualized risk assessment.
Dosage and direction
The standard maintenance dose of Plavix is 75 mg once daily, with or without food. For patients with acute coronary syndrome, a loading dose of 300 mg (four 75 mg tablets) is typically administered initially, followed by the 75 mg daily maintenance dose. The duration of treatment depends on the clinical situation: for recent MI, recent stroke, or established peripheral arterial disease, treatment is typically long-term unless contraindicated. For patients undergoing PCI with stent placement, dual antiplatelet therapy (Plavix plus aspirin) is recommended for at least 1 month for bare-metal stents, 6 months for drug-eluting stents in stable patients, and up to 12 months or longer in patients with acute coronary syndrome. Tablets should be swallowed whole with a glass of water; they should not be crushed, chewed, or broken.
Precautions
Patients should be monitored for signs of bleeding throughout treatment. Genetic testing for CYP2C19 poor metabolizer status should be considered since reduced effectiveness may occur in these patients. Caution is required in patients who may undergo urgent coronary artery bypass graft (CABG) surgery. Discontinuation of Plavix increases the risk of cardiovascular events. Patients should be advised that it may take longer than usual to stop bleeding when taking Plavix, and they should report any unusual bleeding or bruising to their physician. Regular blood tests may be necessary to monitor platelet function. Use with caution in patients with hepatic impairment or severe renal impairment. Patients should inform all healthcare providers, including dentists, that they are taking Plavix before any procedures.
Contraindications
Plavix is contraindicated in patients with active pathological bleeding such as peptic ulcer or intracranial hemorrhage. It should not be used in patients with hypersensitivity to clopidogrel or any component of the formulation. The medication is contraindicated in patients with severe hepatic impairment. Concomitant use with drugs that may cause significant bleeding risk, such as warfarin, NSAIDs, or other antiplatelet agents, requires careful risk-benefit assessment. It is not recommended during pregnancy unless clearly needed and should be avoided in breastfeeding women due to potential risk to the infant.
Possible side effect
The most serious side effect associated with Plavix is bleeding, which can range from minor bruising to severe hemorrhage including gastrointestinal bleeding, intracranial hemorrhage, and retroperitoneal bleeding. Common side effects include bleeding (ecchymosis, epistaxis, hematoma), diarrhea, rash, itching, and abdominal pain. Less frequent side effects may include headache, dizziness, fatigue, hypertension, nausea, dyspepsia, constipation, neutropenia, thrombotic thrombocytopenic purpura (rare), and severe neutropenia (rare). Any signs of unusual bleeding, fever, weakness, paleness, or neurological changes should be reported immediately to a healthcare provider.
Drug interaction
Plavix has significant interactions with several medication classes. Proton pump inhibitors (particularly omeprazole and esomeprazole) may reduce its antiplatelet effect. Concurrent use with warfarin, NSAIDs, heparin, fibrinolytic therapy, or other antiplatelet agents increases bleeding risk. CYP2C19 inhibitors (fluconazole, fluvoxamine, fluoxetine, moclobemide, voriconazole, felbamate, and ticlopidine) may reduce the conversion of clopidogrel to its active metabolite. Conversely, CYP2C19 inducers (rifampin) may increase antiplatelet effects. Caution is advised with selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) due to potential increased bleeding risk.
Missed dose
If a dose of Plavix is missed, the patient should take it as soon as remembered unless it is almost time for the next scheduled dose. In that case, the missed dose should be skipped and the regular dosing schedule resumed. Patients should never take a double dose to make up for a missed one. Consistency in dosing is important for maintaining antiplatelet effect, so patients should establish a routine for taking their medication. If multiple doses are missed, patients should contact their healthcare provider for guidance, as interrupted therapy may increase cardiovascular risk.
Overdose
Plavix overdose may lead to bleeding complications. There is no specific antidote for clopidogrel overdose. Management should focus on clinical monitoring and supportive care, including blood count monitoring and assessment for signs of bleeding. Platelet transfusion may be considered in cases of serious bleeding, though the irreversible nature of platelet inhibition means transfused platelets may also be affected. Gastric lavage may be considered if ingestion was recent. Activated charcoal may be administered if presented within 1-2 hours of ingestion. Hemodialysis is unlikely to be beneficial due to high protein binding.
Storage
Plavix tablets should be stored at room temperature (15-30°C or 59-86°F) in their original container with the lid tightly closed. The medication should be kept away from excess moisture, heat, and light. Tablets should not be stored in bathroom cabinets where humidity levels may fluctuate. Keep out of reach of children and pets. Do not use tablets that are discolored, damaged, or beyond the expiration date printed on the packaging. Proper disposal of unused medication should follow local regulations, typically through medication take-back programs.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Plavix is a prescription medication that should only be used under the supervision of a qualified healthcare professional. Individual patient needs may vary, and treatment decisions should be made in consultation with a physician who can assess specific health conditions, medication history, and risk factors. The prescribing information provided here may not include all possible uses, directions, precautions, or interactions. Always refer to the official prescribing information and consult with a healthcare provider for personalized medical advice.
Reviews
Clinical trials involving over 100,000 patients have demonstrated Plavix’s efficacy in reducing cardiovascular events. The CAPRIE trial showed Plavix was more effective than aspirin in reducing the combined risk of ischemic stroke, myocardial infarction, or vascular death in patients with recent ischemic stroke, recent MI, or established peripheral arterial disease. The CURE trial demonstrated the benefit of Plavix plus aspirin in patients with acute coronary syndrome without ST-segment elevation. Real-world evidence continues to support its effectiveness, though individual responses may vary based on genetic factors, comorbidities, and concomitant medications. Patient satisfaction surveys indicate general acceptance of the once-daily regimen, with most users reporting manageable side effect profiles when properly monitored.