Plavix side effects and how to avoid them

Plavix side effects include bruising, itching, and diarrhea; however, more serious side effects like bleeding may occur. Learn when to seek medical attention for side effects.

Common Plavix side effects | Bruising | Serious side effects | TTP | Tiredness | Weight loss | Side effects in seniors | How long do side effects last? | Warnings | Interactions | How to avoid side effects

Plavix is the brand name for a drug called clopidogrel. Plavix belongs to a class of medications called antiplatelet drugs that prevent the formation of blood clots. Antiplatelet drugs work by preventing platelets—or blood cells—from sticking together to form a clot that blocks an artery. Over time, the narrowing of arteries can lead to heart diseases like acute coronary syndrome. 

You may be prescribed Plavix if you have unstable angina (chest pain) due to heart problems, peripheral arterial disease, or if you have had a heart attack or ischemic stroke. Plavix can be used alone or with aspirin to prevent blood clotting and lower the risk of having a future heart attack or stroke. Plavix is available as a 300 mg and 75 mg tablet, and the usual dose is 75 mg taken once a day.

Like other antiplatelet drugs, Plavix can cause potentially serious side effects, interact with other medications, and may not be suitable for individuals with certain medical conditions. However, there are ways to minimize or avoid these problems.

RELATED: Learn to recognize the signs of a stroke

Common side effects of Plavix

The most common side effects of Plavix are:

• Nosebleeds
• Bruises
• Bleeding that takes longer to stop 
• Itching
• Diarrhea
• Stomach pain
• Indigestion

Bruising

Bruising is one of the most common side effects of Plavix. Bruises form when small blood vessels under the skin break, leading to localized bleeding. Because Plavix works by thinning the blood, you might experience bruising more easily and often while taking this medication. Other signs of minor bleeding such as prolonged nosebleeds, bleeding gums, heavy periods, and cuts that take longer to stop bleeding may also occur. 

In clinical trials, these side effects went away after the first few months of therapy. Individuals should speak with their healthcare provider and seek medical attention if they have bruises that are very large, happen without a known cause, or that last a long time.

Serious side effects of Plavix

Serious side effects of Plavix happen rarely but can occur. Tell your healthcare provider if you have any of the following serious side effects or if you have any side effect that bothers you or doesn’t go away. The most serious side effects of Plavix are:

• Pink, red, or brown urine
• Red or black, tarry stools
• Coughing up or vomiting blood that looks like coffee grounds
• Unusual or unexpected bruises or bleeding
• Stomach ulcers
• Thrombotic thrombocytopenic purpura 
• Low white blood cell count
• Aplastic anemia
• Allergic reaction (hives, swelling of the face or hands, chest tightness, shortness of breath)
• Redness, rash, peeling, and inflammation of the skin 
• Stevens-Johnson syndrome
• Yellowing of the skin or eyes, indicating liver problems
• Joint or muscle pain
• Severe stomach pain
• Dizziness and low blood pressure
• Loss of taste

Thrombotic thrombocytopenic purpura

Thrombotic thrombocytopenic purpura (TTP) is a condition that causes small blood clots to form in blood vessels throughout the body, blocking blood flow to vital organs. TTP occurs in one out of 8,500 to 26,000 people who use Plavix, and symptoms usually appear within the first two weeks of medication use. Although it has a low incidence, TTP is a life-threatening condition that requires immediate medical attention. Get medical help right away if you notice any of the following TTP symptoms when starting Plavix therapy:

• Red or purple spots on the skin or in the mouth
• Yellowing of the skin or eyes
• Weakness
• Pale skin
• Fever
• Fast heart rate or shortness of breath
• Headache, confusion, or speech changes
• Low amount of urine or having blood or protein in the urine

Tiredness

Plavix may cause symptoms of tiredness or weakness for multiple reasons. Plavix increases the risk of bleeding, and individuals may feel more tired than usual if blood loss occurs. High levels of blood loss can also lead to low blood pressure, which also causes weakness, dizziness, and fatigue. Tiredness may also be a sign of the potentially fatal condition TTP. Individuals that have excessive tiredness or any other symptoms of TTP while taking Plavix should consult their healthcare provider. 

Weight loss

Weight changes, including weight loss, are not commonly seen with Plavix. However, Plavix has been shown to cause loss of taste in a few individuals within the first two to eight weeks of taking the medication. Patients who lose their sense of taste may also have decreased appetite, leading to weight loss. It’s not known why Plavix causes loss of taste, but this side effect should go away after stopping the medication.

Plavix side effects in the elderly

Plavix is generally safe and effective in older adults, and there are no restrictions for its use in this population. However, seniors have a higher risk of bleeding from Plavix due to factors such as being frail, being at risk for falls, and having multiple comorbidities like diabetes, high blood pressure, and liver or kidney problems.  

In a clinical trial of 730 patients older than 74 years old who used Plavix for one year, 2.7% of patients had major bleeding. In addition, older individuals are especially at risk for upper gastrointestinal bleeding while taking Plavix and should be closely monitored for signs of dark, tarry stools or vomiting blood.

How long do Plavix side effects last?

Plavix has a short half-life of six hours, meaning that most of the drug is cleared from the body within 24 hours. It takes longer for platelet function to return to normal. After stopping Plavix, platelet levels recover in about a week, and most side effects should also fade by then after the medication is discontinued. 

Some individuals will need to take Plavix long-term. Bleeding, the most common side effect, tends to occur in the first few months of therapy and goes away afterward as the body adjusts to the medication. 

Serious side effects such as TTP, allergic reactions, severe bleeding, and liver problems require immediate medical attention because they can cause permanent complications.

Plavix contraindications and warnings

Some people may not be able to take Plavix because of pre-existing health conditions that affect its safety and effectiveness. 

Abuse and dependence

Plavix is not addictive or habit-forming, and there are no withdrawal symptoms associated with discontinuing Plavix.

Overdose

Up to 600 mg of Plavix can be given as a single loading dose, and the usual daily dose is 75 mg. Plavix has an irreversible effect on platelets that lasts for the entire lifespan of the platelet (8-10 days), so an overdose of Plavix may result in fatal bleeding complications. Other signs of Plavix overdose include vomiting and difficulty breathing. Any known or suspected overdose of Plavix requires emergency treatment.

Restrictions

Plavix has contraindications for use, meaning that it cannot be given to individuals with certain conditions. Plavix is contraindicated in the following populations:

• Individuals with active bleeding such as a peptic ulcer or brain bleed
• Those with a known hypersensitivity to Plavix or any component of the drug

Plavix should also be used with caution in individuals with liver and kidney problems, gastrointestinal disorders, or pre-existing bleeding disorders like hemophilia.  

Individuals who are poor metabolizers of Plavix

The effectiveness of Plavix is dependent on the body’s metabolism—or processing—of the drug. Plavix is metabolized by a specific enzyme protein in the liver called CYP2C19. Some individuals have little or no levels of working CYP2C19 due to genetic differences and are considered “poor metabolizers.” This means that Plavix is not metabolized to its active form and won’t be effective in preventing blood clots. There are genetic tests available to identify people who are poor metabolizers of Plavix, and these individuals may benefit from using a different antiplatelet drug. 

Pregnancy and nursing

Plavix is not expected to be harmful to an unborn baby based on limited evidence. However, there is an increased risk of bleeding if Plavix is used during labor, delivery, or with an epidural. For this reason, it’s recommended to stop Plavix five to seven days before giving birth. It’s not known whether Plavix passes into breast milk. Pregnant or nursing women should speak to a healthcare professional to weigh the risks and benefits of Plavix use.

Children

Plavix is not approved by the Food and Drug Administration (FDA) for use in children, and its safety has not been established in this population. Plavix is sometimes used off-label in children with cardiovascular diseases and given at lower doses based on body weight. 

Plavix interactions

Serious drug interactions can happen when Plavix is taken with other prescription drugs or over-the-counter (OTC) medicines. It is important to tell your healthcare provider about the medications and supplements you take prior to starting Plavix. The following medications and foods should be avoided while on Plavix:

• Prilosec (omeprazole) and Nexium (esomeprazole): These two drugs reduce the antiplatelet activity of Plavix and make it less effective when taken together.
• Opioids: Opioid drugs such as oxycodone slow gastric emptying and reduce the absorption of Plavix.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): Using Plavix together with ibuprofen, naproxen, or other NSAIDs greatly increases the risk of bleeding.
• Warfarin: Blood thinners like warfarin also cause bleeding side effects, so this risk is multiplied with Plavix. 
• Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs): These types of antidepressants affect platelet activation and are associated with higher levels of bleeding when taken with Plavix.
• Prandin (repaglinide): Plavix increases the level of repaglinide in the body. The dose of repaglinide should be lowered if used with Plavix.
• Drugs that increase or decrease CYP2C19 activity: Plavix is activated by the liver enzyme CYP2C19. Any medications that affect CYP2C19 activity will also affect the effectiveness of Plavix. 
• Grapefruit juice: Grapefruit interacts with liver enzymes and makes Plavix less effective.  

How to avoid Plavix side effects

1. Take this medication as directed

Take Plavix exactly as instructed. Your pharmacist should also provide you with a medication guide. The typical dose is 75 mg daily and taken in combination with aspirin. If you miss a dose, take Plavix as soon as you remember. If it’s almost time for the next dose, skip the missed dose and take the next dose at the usual time. Do not take two doses at the same time. If you take too much Plavix, seek emergency care immediately.

2. Do not discontinue this medication without seeking medical advice

Plavix is meant to be used as a long-term treatment, and stopping this medication can increase the risk of heart attack or stroke. Follow your healthcare provider’s instructions about how long to take Plavix. 

3. Inform your healthcare provider of an upcoming surgery or dental procedures

Talk with your healthcare provider about stopping Plavix before having surgery or a dental procedure. You may be instructed to stop the medication at least five days before the procedure to avoid excessive bleeding.

4. Avoid taking this medication with certain proton pump inhibitors (PPIs)

Prilosec and Nexium are commonly used PPIs that are available OTC and should be avoided with Plavix. Other PPI drugs like Protonix (pantoprazole) can be used instead. 

5. Be careful while using sharp objects

While using this medication, bleeding may take longer than usual to stop. Be careful when using sharp objects like scissors and knives, and avoid activities like rough sports that can lead to injuries, bruises, or cuts.

6. Watch for signs of unusual bleeding

Inform your healthcare provider right away if you are coughing up or vomiting blood, have blood in the urine, red or black stools, or bruises that appear without a known cause. 

7. Tell your healthcare provider about all medical conditions

Serious side effects of Plavix can be avoided by telling your healthcare provider about all past and current medical conditions, especially the following: 

• Peptic ulcers or other gastrointestinal disorders
• Bleeding in the brain
• Bleeding disorders like hemophilia
• Liver problems
• Kidney problems
• Any history of drug allergies

Also inform your healthcare provider if you are pregnant, planning on becoming pregnant, or are breastfeeding.

8. Tell your healthcare provider about all medications being taken

Drug interactions between Plavix and other medications can lead to serious side effects. Tell your healthcare provider about all prescription drugs and OTC medicines you’re taking, especially the following:

• Prilosec (omeprazole) and Nexium (esomeprazole)
• Opioids such as oxycodone
• NSAIDs
• Blood thinners such as warfarin 
• SSRIs and SNRIs 
• Prandin (repaglinide)

9. Store Plavix correctly and out of the reach of children

Plavix should be stored at room temperature (77°F) in a sealed container away from light, moisture, and heat. This medication must be kept out of the reach of children.

Resources for Plavix side effects

• Plavix, Epocrates
• Plavix prescribing information, U.S. National Library of Medicine
• Patients with prior myocardial infarction, stroke, or symptomatic peripheral arterial disease in the CHARISMA trial, Journal of the American College of Cardiology
• Ticlopidine-, clopidogrel-, and prasugrel-associated thrombotic thrombocytopenic purpura: a 20-year review from the Southern Network on Adverse Reactions (SONAR), Seminars in Thrombosis and Hemostasis
• Loss of taste with clopidogrel, Canadian Family Physician 
• Comparison of reduced-dose prasugrel and standard-dose clopidogrel in elderly patients with acute coronary syndromes undergoing early percutaneous revascularization, Circulation

Plavix – Uses, Side Effects, Interactions

How does this medication work? What will it do for me?

Clopidogrel belongs to the class of medications called platelet aggregation inhibitors or antiplatelets. Clopidogrel is used to help prevent heart attacks, strokes, and other circulation problems for people who have atherosclerosis (narrowed blood vessels caused by “hardening of the arteries”) and have already experienced at least one atherothrombotic event such as heart attack or stroke, or have been diagnosed with peripheral arterial disease (problems with blood flow in the arteries). It is also used with ASA (acetylsalicylic acid) by people with acute coronary syndrome or atrial fibrillation (a fast, irregular heartbeat) to reduce the risk of heart attack or stroke.

Normally, platelets help the blood to clot when needed, such as after an injury. When arteries become narrowed by fat deposits (plaques), platelets often clump together in the vessels. Unstable plaques can rupture, leading to additional platelet clumping that can cause a larger blockage of the artery. This further narrows the arteries and increases the chances of heart attack, stroke, or other circulation problems. Clopidogrel reduces the chances of these events by preventing platelets from forming into clumps.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

75 mg
Each round, pink, biconvex, film-coated tablet, engraved with “75” on one side and “1171” on the other, contains clopidogrel bisulfate 97. 9 mg which provides 75 mg of clopidogrel base. Nonmedicinal ingredients: hydrogenated castor oil, low substituted hydroxypropyl cellulose, mannitol, microcrystalline cellulose, and polyethylene glycol 6000; coating: carnauba wax, hypromellose, lactose, red iron oxide, titanium dioxide, and triacetin.

300 mg
Each oblong, pink, film-coated tablet, engraved with “300” on one side and “1332” on the other, contains clopidogrel bisulfate 391.5 mg which provides 300 mg of clopidogrel base. Nonmedicinal ingredients: hydrogenated castor oil, low substituted hydroxypropyl cellulose, mannitol, microcrystalline cellulose, and polyethylene glycol 6000; coating: carnauba wax, hypromellose, lactose, red iron oxide, titanium dioxide, and triacetin.

How should I use this medication?

The recommended adult dose of clopidogrel for most conditions is 75 mg once daily. When used by people with acute coronary syndromes, a 300 mg “loading dose” is initially prescribed. After this, treatment starts with 75 mg of clopidogrel once daily.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

Clopidogrel may be taken with or without food.

It is important that this medication be taken exactly as prescribed by your doctor. If you miss a dose within 12 hours of your usual time, take it as soon as possible and continue with your regular dosing schedule. If it is more than 12 hours, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take clopidogrel if you:

• are allergic to clopidogrel or any ingredients of the medication
• have an active bleeding condition such as a stomach ulcer or a brain hemorrhage
• have significant liver disease or cholestatic jaundice
• are taking the medication repaglinide

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• changed sense of taste
• constipation
• diarrhea
• dizziness
• headache
• heartburn
• joint or muscle pain
• nausea
• vomiting

Although most of the side effects listed below don’t happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• abdominal pain
• enlargement of breast tissue in men
• flu-like symptoms (sudden lack of energy, fever, cough, sore throat)
• symptoms of pneumonia (e. g., cough, fever, trouble breathing, night sweats)
• signs of bleeding (e.g., nosebleeds, blood in urine, coughing blood, bleeding gums, unusual bruising or bleeding)
• signs of infection (symptoms may include fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness)
• skin rash or itching
• symptoms of liver problems (i.e., yellowing of the skin or eyes, dark urine, light coloured stools, vomiting, nausea, abdominal pain)
• symptoms of low blood sugar (e.g., cold sweat, cool pale skin, headache, fast heartbeat, weakness)
• tingling sensation in the hands, arms, feet, or legs

Stop taking the medication and seek immediate medical attention if any of the following occur:

• chest pain
• signs of bleeding in the brain (e.g., sudden severe headache, weakness, loss of speech or vision, confusion, seizures, loss of consciousness)
• signs of bleeding in the stomach (e. g., bloody, black, or tarry stools; spitting up blood; vomiting blood or material that looks like coffee grounds)
• signs of a serious allergic reaction (i.e., swelling of face or throat, hives, or difficulty breathing)
• signs of stroke (e.g., sudden or severe headache; sudden loss of coordination; vision changes; sudden slurring of speech; or unexplained weakness, numbness, or pain in arm or leg)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Allergy: Some people who are allergic to other antiplatelet medications such as ticlopidine or prasugrel also experience allergic reactions to clopidogrel. Before you take clopidogrel, tell your doctor about any previous adverse reactions you have had to medications, especially anti-platelet medications. Contact your doctor at once if you experience signs of an allergic reaction, such as skin rash, itching, difficulty breathing, or swelling of the face and throat.

Bleeding problems: Clopidogrel increases the risk of bleeding. Using other medications (e.g., certain antidepressants, NSAIDs) may further increase the risk of bleeding. If you have a history of bleeding disorders, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. If you experience signs of serious or excessive bleeding (e.g., bleeding from rectum, easy bruising, bloody urine, dark stools, persistent abdominal pain and vomiting), contact your doctor immediately.

Thrombotic thrombocytopenic purpura is a rare condition that may occur while taking clopidogrel and requires immediate medical attention. Symptoms include decreased number of blood cells, reduced kidney function, and fever. Seek immediate medical attention if you experience any of these symptoms while taking this medication.

Blood glucose: When combined with clopidogrel, certain medications for type 2 diabetes (repaglinide) cause dangerously low blood glucose levels. If you have type 2 diabetes, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Kidney function: If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Lactose intolerance: This medication contains lactose. If you have galactose intolerance (galactosemia, glucose-galactose malabsorption, or Lapp lactase deficiency) you should not take this medication.

Liver function: Liver disease or decreased liver function can affect how this medication works for you. If you have reduced liver function or liver disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

People with severely reduced liver function should not take clopidogrel.

Proton pump inhibitors: Proton pump inhibitors (PPIs) are medications such as omeprazole and lansoprazole that are taken to treat stomach ulcers and severe heartburn. When clopidogrel is taken by people who are also taking a PPI, clopidogrel may be less effective, depending on the PPI that is used. If you are taking a medication in this class, discuss with your doctor whether you should continue to take it, or whether another medication may be more appropriate.

Stomach problems: Since clopidogrel can increase the risk of bleeding and slow down the time it takes to form a clot, it is important to remind your doctor if you have had stomach ulcers. Ask the doctor or your pharmacist to review your medications if they may cause stomach ulcers (e.g., NSAIDs such as ibuprofen, naproxen, and others).

Surgery: Your doctor may want to stop clopidogrel for a several days prior to any planned surgery to prevent any unnecessary bleeding, so it is important to tell all of your doctors that you are taking clopidogrel.

Pregnancy: The medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: It is not known if clopidogrel passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children.

What other drugs could interact with this medication?

There may be an interaction between clopidogrel and any of the following:

• acetylsalicylic acid (ASA)
• amiodarone
• anagrelide
• anticoagulants (e. g., apixaban, dabigatran, edoxaban, enoxaparin, heparin, rivaroxaban, warfarin)
• antiplatelet medications (e.g., clopidogrel, prasugrel, ticagrelor, ticlopidine)
• apalutamide
• “azole” antifungals (e.g., fluconazole, ketoconazole, voriconazole)
• bupropion
• cannabis
• calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil)
• cobicistat
• desloratadine
• dipyridamole
• enzalutamide
• fentanyl
• ginger
• ginkgo biloba
• ginseng
• glucosamine
• grapefruit juice
• HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e.g., efavirenz, etravirine, nevirapine)
• moclobemide
• morphine
• multivitamins with or without minerals
• nonsteroidal anti-inflammatories (NSAIDs; e.g., ibuprofen, diclofenac, ketorolac, naproxen)
• obinutuzumab
• omega-3 fatty acids
• oseltamivir
• paclitaxel
• pentosan polysulfate sodium
• pentoxifylline
• pioglitazone
• certain protein kinase inhibitors (e. g., dabrafenib, dasatinib, pazopanib)
• proton pump inhibitors (PPIs; e.g., esomeprazole, lansoprazole, omeprazole, pantoprazole)
• repaglinide
• rifampin
• rosuvastatin
• selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, fluoxetine, paroxetine, sertraline)
• serotonin-norepinephrine reuptake inhibitors (SNRIS; desvenlafaxine, duloxetine, venlafaxine)
• tipranavir
• topotecan
• vitamin E

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

All material copyright MediResource Inc. 1996 – 2023. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/drug/getdrug/Plavix

Providing medical care for myocardial infarction, an alternative to drug treatment

Session 3

“Providing medical care for myocardial infarction, an alternative to drug treatment”

In such a serious condition as myocardial infarction, emergency hospitalization is required, when trying to provide assistance at home, you can lose too much time, and therefore, if an attack of angina pectoris does not stop within 30 minutes, you must urgently call an ambulance.

Treatment of myocardial infarction must be carried out only in a hospital in the intensive care unit. Moreover, the faster the patient is taken there, the more effective the result of subsequent treatment will be – it is important to focus the attention of patients on this.

Patients with myocardial infarction are delivered on a stretcher or on a gurney to the intensive care cardiology department or to specialized units or intensive care units. With an uncomplicated course of the disease, the patient stays in the intensive care unit for 3-5 days.

Currently, the duration of hospitalization of a patient with uncomplicated myocardial infarction is about three weeks, the duration of hospitalization is determined by the attending physician and depends on the course of the disease.

Treatment of myocardial infarction begins with pain control. The most effective for the rapid removal of an angina attack are drugs belonging to the NITRATE group: tablets or in the form of aerosols.

NITROGLYCERIN is the international name for the drug. Different manufacturers produce it under their trade names, which are listed below.

How do nitroglycerin preparations work?

Nitrates dilate the arteries of the heart and improve the supply of oxygen to the heart. Nitrates also reduce the workload on the heart. In general, this can reduce the incidence and severity of pain behind the sternum.

What are the rules for taking nitroglycerin preparations?

Take your medicine exactly as directed by your doctor. Do not stop taking nitroglycerin without first talking to your doctor.

Never take more nitroglycerin than prescribed by your doctor.

During treatment, carry the medicine pack with you, keep a constant supply of the drug.

This medicine has been prescribed for you only. Never give it to other people, even if you think they have the same disease.

What if you miss a dose?

Take the missed dose as soon as you remember.

If you missed one dose of the medicine, and it is already time for the next dose, continue taking the drug at the recommended dose.

Do not take a double or extra dose of the medicine.

What is needed for treatment to be effective and safe?

If you get up suddenly, you may feel dizzy, weak, dark in the eyes. To avoid this problem, try to get up slowly. If you still feel these symptoms, you must again take a horizontal position, then slowly sit down and, in the absence of these manifestations, slowly stand up.

Avoid alcohol during treatment as it may aggravate dizziness.

Before any surgery, including dental care, tell your doctor that you are taking nitroglycerin.

What problems can nitrates cause?

Along with the benefits, all medicines can cause unwanted (adverse) reactions. They usually disappear or decrease after your body gets used to the medicine.

Talk to your doctor if you experience any of the following side effects: throbbing headache, flushing of the face, hot flashes, dizziness, irregular heartbeat, rapid heartbeat.

You can talk to your doctor about any other concerns that you think are related to taking this medicine.

If chest pain cannot be relieved with nitroglycerin or other nitrates, narcotic analgesics are given intravenously. Pain must be removed because it can lead to cardiogenic shock from which the patient is very difficult to extricate.

There are three ways to improve coronary blood flow:

1. Dissolve a clot that has formed in an artery. This is the most modern method of treatment and it is called thrombolysis. The sooner the drug is administered to dissolve the blood clot, the better the result. The maximum effect is achieved within the first hour from the onset of myocardial infarction. This hour is even called “golden”. When the thrombus dissolves after 6 hours, only about 5% of the affected heart muscle can be saved. The drugs belonging to the FIBRINOLYTICS group (alteplase, streptokinase, tenecteplase, urokinase) are used.

How does the drug work?

dissolve a blood clot formed in an artery.

What problems can fibrinolytics cause?

Along with the benefits, all medicines can cause unwanted (adverse) reactions.

Bleeding from injection sites (does not require premature discontinuation of therapy) is the most common complication when using the drug.

Cardiac arrhythmias

You can talk to your doctor about any other concerns that you think are related to taking this medicine.

2. Reduce the load on the heart. Drugs are prescribed that reduce blood pressure, reduce the volume of circulating blood, slow down the heart rate and thereby reduce the need for oxygen in the heart muscle and prolong the life of starving cells in the infarction zone.

This group includes β-ADRENOBLOCKERS.

This group has an active antianginal, antiarrhythmic effect. High efficiency is achieved by regulating the needs of your heart and the capacity of your coronary arteries, i.e. transfers the work of your heart to a more economical mode.

If you are prescribed this group of drugs, you must monitor your pulse rate and blood pressure. They reduce the heart rate (it is desirable that it be 55-60 beats per minute at rest), dilate the vessels of the heart, lower blood pressure (should be less than 140/90 mm Hg).

Remember that this group of drugs is used for a long time, you can not skip and stop taking the drug without the knowledge of the doctor, when you cancel it is necessary to gradually reduce the dose over several days. The use of β-blockers reduces mortality after MI during the first year by 25%.

Bisoprolol is the international name of the medicine. Different manufacturers produce it under their trade names, which are listed below.

Aritel, Bidop, Biprol, Bisocard, Bisoprolol hemifumarate, Bisoprolol fumarate, Concor, Concor Cor, Corbis, Coronal

CARVEDILOL is the international name of the drug. Different manufacturers produce it under their trade names, which are listed below.

Acridilol, Atram, Vedicardol, Dilatrend, Carvedigamma, Carvedilol, Carvedilol Obolenskoe, Carvetrend, Carvidil, Cardivas, Coriol, Talliton

Metoprolol is the international name of the drug. Different manufacturers produce it under their trade names, which are listed below.

Betaloc, Vasocardin, Vasocardin retard, Corvitol 100, Corvitol 50, Metoprolol, Metoprolol Acry, Metoprolol Ratiopharm, Metoprolol tartrate, Egilok, Egilok retard

How does the drug work?

Bisoprolol, metoprolol, carvedilol reduce the intensity of the heart, its need for oxygen, lower blood pressure, and restore impaired function of the heart muscle.

What if you miss a dose?

Take the missed dose as soon as you remember.

If you miss one dose of your medication and it’s already time for your next dose, continue on your regular schedule.

Do not take a double or extra dose of the medicine.

What is needed for treatment to be effective and safe?

If you have diabetes, check your blood glucose regularly.

Before any surgery, including dental care, tell your doctor that you are taking bisoprolol.

Follow your doctor’s dietary advice.

What problems can beta-blockers cause?

Along with the benefits, all medicines can cause unwanted (adverse) reactions.

Talk to your doctor if you experience any of the following side effects: dizziness, increased fatigue, chilliness of the extremities, sleep disturbance, nightmares, shortness of breath, skin rash, dry eyes, sexual problems, difficulty urinating, chilliness or excessive sweating, the appearance or increase of shortness of breath, the appearance or increase of edema, nasal congestion, sleep disturbance.

Any other concerns that you think are related to taking this medicine can be discussed with your doctor.

ANGIOTENSIN-CONVERTING ENZYME INHIBITORS (captopril, enalapril, lisinopril, fosinopril, perindopril, etc.) also protect the heart and blood vessels from pathological changes leading to the development of heart failure. ENALAPRIL is the international name for the drug. Different manufacturers produce it under their trade names, which are listed below.

Bagopril, Berlipril 5, Berlipril 10, Berlipril 20, Vasopren, Vero-Enalapril, Invoril, Renipril, Renitec, Ednit, Enalapril, Enalapril-ICN, Enalapril-Acre, Enalapril Hexal, Enalapril-Ros, Enalapril-FPO, Enalapril Maleate, Enam, Enan NM, Enap, Enarenal, Enafarm, Envas

Lisinopril is the international name of the drug. Different manufacturers produce it under their trade names, which are listed below.

Diroton, Irumed, Lizacard, Lysigamma, Lisinopril, Lisinopril Stada, Lisinopril dihydrate, Lysinoton, Lysoril, Listril, Liten, Sinopril

PERINDOPRIL is the international name of the drug. Different manufacturers produce it under their trade names, which are listed below.

Hypernic, Coverex, Perindopril, Perindopril erbumine, Perinpress, Prenessa, Prestarium

How does the drug work?

Angiotensin-converting enzyme inhibitors dilate blood vessels, lower blood pressure, and increase the efficiency of the heart.

Along with the benefits, all medicines can cause unwanted (adverse) reactions.

Talk to your doctor if you experience any of the following side effects: cough, dizziness, headache, insomnia or drowsiness, severe weakness, skin rash, itchy skin, fever, facial flushing, cough, nasal congestion, sore throat, pain in the abdomen, loose stools, constipation, rapid heartbeat, unusual taste in the mouth.

It is necessary to draw the attention of patients that the most common side effect of ACE inhibitors is cough – occurs in up to 20% of cases in women:

Important! Seek immediate medical attention if there is sudden swelling of the tongue, lips, or eyelids.

You can talk to your doctor about any other concerns that you think are related to taking this medicine.

3. Improve the rheological properties of blood – reduce the ability of blood to form clots (anticoagulants, antiaggregants).

You will be prescribed DIRECT-ACTING ANTICOAGULANTS in the form of injections (sodium heparin, sodium enoxaparin, sodium dolteparin, calcium nadroparin). SODIUM HEPARIN is the international name for the drug. Different manufacturers produce it under their trade names, which are listed below.

Heparin, Heparin “Biochemi”, Heparin BS, Heparin Lechiva, Heparin sodium, Heparin – Richter, Heparin – Ferein

ENOXAPARIN SODIUM is the international name of the drug

DALTEPARIN SODIUM is the international name of the drug.

NADROPARIN CALCIUM is the international name of the drug.

How does the drug work?

Direct acting anticoagulants reduce the ability of the blood to form blood clots (clots).

Rules for the introduction of the solution.

The solution is injected subcutaneously into the anterolateral region of the abdominal wall at the level of the belt.

The patient must lie down during the injection.

For injection, the needle is inserted vertically to its full length into the thickness of the skin, clamped in the fold.

The skin fold is not straightened until the end of the injection.

Do not rub the injection site after injection.

What problems can the drug cause?

Along with the benefits, all medicines can cause unwanted (adverse) reactions.

After s / c injection, pain at the injection site, bruising (hematoma) at the injection site may be observed. In some cases, the formation of solid inflammatory seals (infiltrates) containing the drug is possible, which resolve after a few days, and drug withdrawal is not required.

Possible bleeding from mucous membranes and wounds

Important! Seek immediate medical attention if you experience any of the following symptoms: rhinitis, urticaria, watery eyes, fever, bronchospasm.

You can talk to your doctor about any other concerns that you think are related to taking this medicine.

To prevent the formation of blood clots in the vessels of the heart, you need to constantly take drugs that reduce blood clotting – ANTIAGREGGANTS, usually acetylsalicylic acid 125 mg / day and clopidogrel 75 mg / day. acetylsalicylic acid is the international name for the drug. Different manufacturers produce it under their trade names, which are listed below.

ASK-Cardio, ascopirin, aspirals, aspicor, aspin, aspin 300, alcohol aspinate, Aspinate Cardio, Aspirin 1000, Aspirin 1000, Aspitrin, Aserol, Azecardol, acetylsalicylic acid, acetylsalicylic acid “Jork”, acetylsalicylic acid MS, acetylsalicylic acid-zeros. , Acetylsalicylic Acid-UBF, Acsbirin, CardiASK, Cardiopyrin, Nekstrim Fast, Taspir, Therapin, Thrombo ASS, Upsarin Upsa, Fluspirin

How does the drug work?

Acetylsalicylic acid reduces inflammation, pain and lowers body temperature. In addition, acetylsalicylic acid reduces the formation of blood clots (blood clots).

What if you miss a dose?

Take the missed dose as soon as you remember.

If you miss one dose of your medication and it’s already time for your next dose, continue on your regular schedule.

Do not take a double or extra dose of the medicine.

What is needed for treatment to be effective and safe?

Take your medicine at the same time of day.

If you need to take acetylsalicylic acid with other medicines, ask your doctor about the safety of this combination.

Try to avoid bumps, cuts and any other injury, as acetylsalicylic acid reduces blood clotting.

What problems can acetylsalicylic acid cause?

Along with the benefits, all medicines can cause unwanted (adverse) reactions.

Talk to your doctor if you experience any of the following side effects: stomach pain, heartburn, nausea.

Important! Seek immediate medical attention if you experience the following symptoms: swelling of the face, mouth, neck, skin rash; shortness of breath or choking; black or bloody stools, as well as red urine; deafness.

You can discuss any other sensations that bother you, which, from your point of view, are associated with taking this medicine. Different manufacturers produce it under their trade names, which are listed below.

Zilt, Clopidogrel Hydrosulfate, Plavix

How does the drug work?

Clopidogrel inhibits the ability of platelets (platelets) to connect to each other, which prevents the formation of blood clots (blood clots) in blood vessels.

What if you miss a dose?

Take the missed dose as soon as you remember.

If you miss one dose and it’s time for your next dose, continue taking the recommended dose.

Do not take a double or extra dose of the medicine.

What is needed for treatment to be effective and safe?

Before taking any over-the-counter medication, check with your doctor about how safe it is to combine with clopidogrel.

Do not take aspirin or other medicines containing acetylsalicylic acid unless your doctor tells you to.

Clopidogrel may cause dizziness.

What problems can clopidogrel cause?

Along with the benefits, all medicines can cause unwanted (adverse) reactions.

Talk to your doctor if you experience any of the following side effects: abdominal discomfort or pain, fatigue, loose stools, constipation, headache, dizziness, incoordination, tingling sensation in the limbs, skin rash, or itching.

Important! Seek immediate medical attention if bruising, bleeding, blood in the urine, or black stools appear for no apparent reason.

You can talk to your doctor about any other concerns that you think are related to taking this medicine.

Very important medicines that lower the concentration of cholesterol in the blood – STATINS. They reduce the size of existing atherosclerotic plaques and prevent the formation of new ones. The risk of death with continuous use of statins is reduced by 30-40%.

simvastatin, atorvastatin, rosuvastatin

International drug name. Different manufacturers produce it under their trade names.

How do drugs work?

Reduce the formation of cholesterol in the liver, which further leads to a decrease in cholesterol in the blood.

What if you miss a dose?

Take the missed dose as soon as you remember.

If you miss one dose and it’s time for your next dose, continue taking the recommended dose.

Do not take a double or extra dose of the medicine.

What is needed for treatment to be effective and safe?

Avoid alcohol, as this may reduce the effectiveness of the treatment.

Remember that smoking has a negative effect on your body and reduces the positive effect of the drug.

Grapefruit juice should not be taken with the drug, as this may increase the blood levels of atorvastatin.

Women should use effective contraception during treatment and at least one month after stopping the drug.

Before any surgery, including dental care, tell your doctor that you are taking this medicine.

What problems can statins cause?

Along with the benefits, all medicines can cause unwanted (adverse) reactions.

Talk to your doctor if you experience any of the following side effects: headache, abdominal pain, bloating, diarrhea or constipation, sleep disturbance, loss of appetite, tingling or numbness in the limbs, dizziness, skin rash, sexual problems, chest pain cell.

Important! Seek immediate medical attention if you experience severe weakness, muscle pain, yellowing of the skin.

You can talk to your doctor about any other concerns that you think are related to taking this medicine.

The above drugs are used, as a rule, for a long time, therefore they require medical supervision and an individual approach. Do not forget that if you feel better, in no case should you stop taking the drugs or reduce their dose yourself.

Memorial Sloan Kettering Cancer Center

Adult Medication

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This document, provided by Lexicomp ^® , contains all the information you need to know about this medicine, including indications, directions for use, side effects, and when your healthcare provider should be contacted.

Trade names: USA

Plavix

Trade names: Canada

ACT Clopidogrel; AG-Clopidogrel; APO-Clopidogrel; Auro-Clopidogrel; BIO-Clopidogrel; DOM-Clopidogrel; JAMP-Clopidogrel; M-Clopidogrel; Mar-Clopidogrel; MINT-Clopidogrel; NRA-Clopidogrel; Plavix; PMS-Clopidogrel; PRIVA-Clopidogrel [DSC]; RIVA-Clopidogrel; SANDOZ Clopidogrel [DSC]; TARO-Clopidogrel; TEVA-Clopidogrel

Warning

• This medicine may not work the same way for some people. To find out if you belong to such people, you can do an analysis. It is necessary to consult with your doctor.

What is this drug used for?

• It is used to reduce the risk of myocardial infarction or stroke.
• This drug may also be used for other indications. Consult your doctor.

What should I tell my doctor BEFORE taking this drug?

• If you have an allergy to this drug, any of its ingredients, other drugs, foods or substances. Tell your doctor about your allergies and how they have manifested.
• If you have any of the following health problems: Open bleeding or bleeding problems (such as a brain bleed or bleeding ulcers).
• If you are taking any of the following drugs: esomeprazole, omeprazole, repaglinide, or rifampin.
• If you are taking any medications that may increase your risk of bleeding. There are many drugs that can have this effect. If in doubt, consult your doctor or pharmacist.

This list of drugs and conditions that may interact unfavorably with this drug is not exhaustive.

Tell your doctor and pharmacist about all medicines you take (prescription and over-the-counter, natural products and vitamins) and any health problems you have. You need to make sure that this drug is safe for your conditions and in combination with other drugs you are already taking. Do not start or stop taking any drug or change the dosage without your doctor’s advice.

What do I need to know or do while taking this drug?

• Tell all your health care workers that you are taking this drug. These are doctors, nurses, pharmacists and dentists. You may need to stop taking this drug before certain types of surgery, as told by your doctor. If you stop taking this drug, your doctor will tell you when you can start taking this drug again after your surgery or procedure.
• Do not stop taking this drug without consulting your doctor. This may increase the risk of heart attack or stroke.
• If you fall, are injured, or hit your head, contact your doctor immediately. Consult your doctor even if you feel well.
• You may become more prone to bleeding. Be careful and avoid injury. Use a soft toothbrush and an electric razor. In rare cases, some bleeding has resulted in death.
• Consult your doctor before taking medicines containing aspirin, anticoagulants, garlic, ginseng, ginkgo, ibuprofen or similar compounds, pain relievers, or vitamin E.
• Tell your doctor if you are pregnant, planning to become pregnant, or breastfeeding. The benefits and risks for you and your child will need to be discussed.

What side effects should I report to my doctor immediately?

WARNING. In rare cases, this drug can cause serious and sometimes deadly side effects in some patients. Call your doctor or get medical help right away if you have any of the following signs or symptoms that could be associated with serious side effects:

• Signs of an allergic reaction, such as rash, hives, itching, red and swollen skin with blisters or peeling, possibly accompanied by fever, wheezing or wheezing, tightness in the chest or throat, difficulty breathing, swallowing or speaking, unusual hoarseness, swelling in the mouth, face, lips, tongue or throat.
• signs of bleeding, such as vomiting or coughing up blood; vomiting of the type of coffee grounds; blood in the urine; black, red, or tarry stools; bleeding from the gums; non-cyclic vaginal bleeding; bruises that appear or increase for no reason; bleeding that you cannot stop.
• Symptoms of low blood sugar such as dizziness, headache, drowsiness, feeling weak, trembling, tachycardia, confusion, hunger, or sweating.
• A serious blood disorder known as thrombotic thrombocytopenic purpura (TTP) has happened with this drug. In some cases, this has led to death. If you have confusion, severe fatigue or weakness, weakness on 1 side of the body, difficulty speaking or thinking, balance problems, drooping on one side of the face, or changes in vision, call your doctor right away. If you have tachycardia; heat; headache; skin blanching; a decrease in the volume of urine, a change in its color to pink, the presence of blood in the urine; purple spots on the skin or oral mucosa; convulsions; severe diarrhea; abdominal pain; nausea or vomiting; dyspnea; yellowness of the skin or whites of the eyes, contact your doctor immediately.

What are some other side effects of this drug?

Any drug can cause side effects. However, for many people, side effects are either minor or non-existent. Contact your doctor or seek medical attention if you are concerned about any side effects or if the side effects persist.

This list of possible side effects is not exhaustive. If you have any questions about side effects, please contact your doctor. Talk to your doctor about side effects.

You can report side effects to the National Health Board.

You can report side effects to the FDA at 1-800-332-1088. You can also report side effects at https://www.fda.gov/medwatch.

What is the best way to take this drug?

Use this drug as directed by your doctor. Read all the information provided to you. Strictly follow all instructions.

• Take this drug with or without food.
• Keep taking this drug as instructed by your doctor or other health care professional, even if you feel well.

What if I miss a dose of a drug?

• Take the missed dose as soon as you can.
• If it’s time for your next dose, don’t take the missed dose and then go back to your regular dosing schedule.
• Do not take 2 doses or an additional dose at the same time unless otherwise directed by your healthcare professional.

How do I store and/or discard this drug?

• Store at room temperature in a dry place. Do not store in the bathroom.
• Keep all medicines in a safe place. Keep all medicines out of the reach of children and pets.
• Dispose of unused or expired drugs. Do not empty into a toilet or sewer unless instructed to do so. If you have any questions about disposing of medicines, ask your pharmacist. Drug disposal programs may be in place in your area.

General information about drugs

• If your health does not improve or even worsens, see your doctor.
• Do not give your medicine to anyone and do not take other people’s medicines.
• Some medicines may come with other patient information leaflets. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other health care professional.
• A separate instruction for patients is attached to the drug. Please read this information carefully. Reread it each time you refill your supply. If you have any questions about this drug, ask your doctor, pharmacist, or other health care professional.
• If you think you have overdosed, call a poison control center or get medical help right away. Be prepared to tell or show what drug you took, how much, and when it happened.

Consumer Use of Information and Limitation of Liability

This summary information includes a summary of the diagnosis, treatment, and/or drug product. It is not intended to be a comprehensive source of data and should be used as a tool to help the user understand and/or evaluate potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a particular patient.