Reduction of atherosclerotic events in: recent MI or stroke, established peripheral arterial disease; non-ST-segment elevation acute coronary syndrome (unstable angina/non-ST-elevation MI) or ST-elevation MI; see literature.
75mg once daily. Non-ST-segment acute coronary syndrome (give with aspirin 75–325mg once daily): give one 300mg loading dose first. ST-segment elevation MI (give with aspirin, with or without thrombolytics): may start with or without a loading dose. CYP2C19 poor metabolizers: may need higher doses. If concomitant PPI required: consider acid-reducing agent with minimal or no CYP2C19 inhibitory effect.
Platelet aggregation inhibitor.
Active pathologic bleeding (eg, peptic ulcer, intracranial hemorrhage).
CYP2C19 poor metabolizers: diminished effectiveness and higher cardiovascular event rates. Consider testing for CYP2C19 genotype before starting therapy; consider alternative treatment if identified as poor metabolizer. Risk of bleeding (eg, surgery, ulcers, trauma, concomitant NSAIDs). Consider discontinuing 5 days before elective surgery. Avoid lapses in therapy; if temporarily discontinued, restart as soon as possible. Increased risk of cardiovascular events if discontinued prematurely. Pregnancy (Cat.B). Nursing mothers: not recommended.
Avoid concomitant CYP2C19 inhibitors (eg, omeprazole, esomeprazole, cimetidine, fluconazole, ketoconazole, voriconazole, etravirine, felbamate, fluoxetine, fluvoxamine, ticlopidine). Caution with drugs that increase risk of bleeding (eg, NSAIDs, warfarin), and with drugs metabolized by CYP2C9 (eg, phenytoin, tolbutamide, tamoxifen, warfarin, torsemide, fluvastatin, many NSAIDs).
Bleeding (may be fatal), GI upset/ulcers, bruising, rash, pruritus, headache; rare: thrombotic thrombocytopenic purpura, agranulocytosis.
Tabs 75mg—30, 90, 100, 500; 300mg—30, 100