Clopidogrel

Antiplatelet·Haematology - Antiplatelets

Acute coronary syndromes, recent MI/stroke, established peripheral arterial disease

Authority requiredPBSANTIPLATELETPlavix, Iscover75 mg tablet+2

Max Dose

75 mg OD

Half-life

6 h

Bleeding Risk

HIGH

PPI Interaction

OMEPRAZOLE

Rapid Summary

Overview

Irreversible P2Y12 ADP receptor antagonist. A critical component of Dual Antiplatelet Therapy (DAPT) post-stenting or acute stroke.

Maximum Dose

Max 75 mg OD (Maintenance). Loading doses up to 600 mg.

Clinical Focus

It is a prodrug requiring hepatic activation. Genetic poor-metabolisers will gain zero protection and risk stent thrombosis.

Bottom Line

Clopidogrel is a key antiplatelet for ACS dual therapy and stent protection, but has variable efficacy due to CYP2C19 polymorphisms and must not be combined with omeprazole.

Formulation & Access

Brand Names

Plavix, Iscover

Oral Routes

Tablets (75 mg, 300 mg).

Prescribing & PBS

Authority Required (PBS).

Indications & Use

Primary

PBSTGA

Acute coronary syndromes, recent MI/stroke, established peripheral arterial disease.

Clinical Place

Standard partner to Aspirin in DAPT. Often chosen over Ticagrelor when bleeding risk is high or the patient is frail.

Quick reference

Class & Role

Antiplatelet — Irreversible P2Y12 ADP receptor antagonist.

Route / Formulation

Tablets (75 mg, 300 mg). (Plavix, Iscover)

Usual Dose & Max

PO 300-600 mg STAT (Loading dose), followed by 75 mg OD. Max 75 mg OD (Maintenance). Loading doses up to 600 mg.

Key Indication Doses

Acute ACS / STEMI: PO 300-600 mg STAT (Loading dose), followed by 75 mg OD. Secondary Prevention / Post-Stroke: PO 75 mg OD.

Best Uses

Clopidogrel is a key antiplatelet for ACS dual therapy and stent protection, but has variable efficacy due to CYP2C19 polymorphisms and must not be combined with omeprazole.

Avoid / Cautions

Active pathological bleeding (peptic ulcer, intracranial haemorrhage). Pregnancy Category B1.

Key Risks

Haematological: Bleeding, bruising, epistaxis. RARE — Thrombotic thrombocytopenic purpura (TTP). Gastrointestinal: GI haemorrhage, dyspepsia. Dermatological: Rash, pruritus.

Key Interactions

Omeprazole and Esomeprazole strongly inhibit CYP2C19. This prevents Clopidogrel from converting into its active form, leading to fatal stent thrombosis. Use Pantoprazole instead. Anticoagulants, NSAIDs, SSRIs (additive bleeding risk).

Monitoring

Monitor for signs of bleeding. Baseline FBC. No routine coagulation monitoring required.

Clinical Pearl

If a patient on Clopidogrel needs gastric protection, ONLY prescribe Pantoprazole or Rabeprazole. Omeprazole will shut down the drug's efficacy.

Access

Authority requiredPlavix, Iscover75 mg tablet

Brand: Plavix, Iscover
PBS status: Authority required
Formulation: Tablets (75 mg, 300 mg)

Clopidogrel

Antiplatelet·Haematology - Antiplatelets

Acute coronary syndromes, recent MI/stroke, established peripheral arterial disease

Authority requiredPBSANTIPLATELETPlavix, Iscover75 mg tablet+2

Max Dose

75 mg OD

Half-life

6 h

Bleeding Risk

HIGH

PPI Interaction

OMEPRAZOLE

Rapid Summary

Overview

Irreversible P2Y12 ADP receptor antagonist. A critical component of Dual Antiplatelet Therapy (DAPT) post-stenting or acute stroke.

Maximum Dose

Max 75 mg OD (Maintenance). Loading doses up to 600 mg.

Clinical Focus

It is a prodrug requiring hepatic activation. Genetic poor-metabolisers will gain zero protection and risk stent thrombosis.

Bottom Line

Clopidogrel is a key antiplatelet for ACS dual therapy and stent protection, but has variable efficacy due to CYP2C19 polymorphisms and must not be combined with omeprazole.

Formulation & Access

Brand Names

Plavix, Iscover

Oral Routes

Tablets (75 mg, 300 mg).

Prescribing & PBS

Authority Required (PBS).

Indications & Use

Primary

PBSTGA

Acute coronary syndromes, recent MI/stroke, established peripheral arterial disease.

Clinical Place

Standard partner to Aspirin in DAPT. Often chosen over Ticagrelor when bleeding risk is high or the patient is frail.

Quick reference

Class & Role

Antiplatelet — Irreversible P2Y12 ADP receptor antagonist.

Route / Formulation

Tablets (75 mg, 300 mg). (Plavix, Iscover)

Usual Dose & Max

PO 300-600 mg STAT (Loading dose), followed by 75 mg OD. Max 75 mg OD (Maintenance). Loading doses up to 600 mg.

Key Indication Doses

Acute ACS / STEMI: PO 300-600 mg STAT (Loading dose), followed by 75 mg OD. Secondary Prevention / Post-Stroke: PO 75 mg OD.

Best Uses

Clopidogrel is a key antiplatelet for ACS dual therapy and stent protection, but has variable efficacy due to CYP2C19 polymorphisms and must not be combined with omeprazole.

Avoid / Cautions

Active pathological bleeding (peptic ulcer, intracranial haemorrhage). Pregnancy Category B1.

Key Risks

Haematological: Bleeding, bruising, epistaxis. RARE — Thrombotic thrombocytopenic purpura (TTP). Gastrointestinal: GI haemorrhage, dyspepsia. Dermatological: Rash, pruritus.

Key Interactions

Monitoring

Monitor for signs of bleeding. Baseline FBC. No routine coagulation monitoring required.

Clinical Pearl

If a patient on Clopidogrel needs gastric protection, ONLY prescribe Pantoprazole or Rabeprazole. Omeprazole will shut down the drug's efficacy.

Access

Authority requiredPlavix, Iscover75 mg tablet

Brand: Plavix, Iscover
PBS status: Authority required
Formulation: Tablets (75 mg, 300 mg)