To reduce risk of thrombotic cardiovascular events in patients with acute coronary syndrome who are to be managed with percutaneous coronary intervention (patients with unstable angina (UA) or non-ST-elevation myocardial infarction (NSTEMI); patients with ST-elevation MI (STEMI) when managed with either primary or delayed PCI).
Loading dose: 60mg once. Maintenance: 10mg once daily. <60kg: consider 5mg once daily. Take with aspirin (75mg–325mg daily).
P2Y12 platelet inhibitor (thienopyridine).
Active pathological bleeding (eg, peptic ulcer, intracranial hemorrhage). Prior TIA or stroke. Do not start if patient likely to undergo urgent CABG.
≥75yrs: usually not recommended. Weight <60kg, or CABG or other surgery or trauma, recent or recurrent GI bleeding, severe hepatic dysfunction, moderate to severe renal impairment: increased risk of bleeding. Discontinue 7 days before surgery, and if TIA or stroke occurs. Premature discontinuation increases risk for cardiac events (eg, stent thrombosis, MI, death). Pregnancy (Cat.B). Nursing mothers.
Increased bleeding risk with heparin, warfarin, fibrinolytics, chronic NSAID use.
Bleeding (may be fatal), hyper- or hypotension, hyperlipidemia, headache, back pain, GI upset, dizziness, cough, chest pain, atrial fibrillation, leukopenia; rare: thrombotic thrombocytopenic purpura, thrombocytopenia, anemia, abnormal hepatic function, allergic reactions, angioedema.
Tabs 5mg—7, 30; 10mg—30