Clopidogrel

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Jul 08, 2022

Warnings

What are the risks of taking clopidogrel (Plavix)?

Clopidogrel can cause serious health complications in some people. Talk to your healthcare provider or pharmacist if these risks are a concern for you.
Risks of clopidogrel use include:

Genetics and Clopidogrel Efficacy: Platelet inhibitors like clopidogrel (Plavix) can be less effective in some people due to genetics. Certain genes can lead to a diminished antiplatelet response of clopidogrel, meaning the medication does not work properly because of how the body processes it. For example, an enzyme called cytochrome P450 is needed to convert clopidogrel to its active form in the body. People who have a deficiency of cytochrome P450 enzyme are poor metabolizers of the drug, and in such individuals, clopidogrel may not work properly for platelet inhibition. A genetic test can determine if this is the case.
Drug Interactions: Certain medications belonging to a family of drugs called proton pump inhibitors (examples, omeprazole (Prilosec) and esomeprazole (Nexium) can affect clopidogrel efficacy, i.e., they can reduce the antiplatelet effects of this medication and make clopidogrel less effective. If you are taking clopidogrel, don’t start any new medications, including over-the-counter supplements and vitamins, without talking to your doctor or pharmacist first.
Bleeding Risk: Clopidogrel is an antiplatelet drug or blood-thinning medication that can increase your risk of bleeding, including fatal bleeding. Be sure to take clopidogrel exactly as prescribed. Call your doctor immediately if you notice any unusual bruising, excessive bleeding, or major bleeding that does not stop. Also, tell your doctor if you see any blood in your urine, stool, or vomit - these can be signs of gastrointestinal (stomach) bleeding. Other signs and symptoms of serious bleeding can include dizziness and low blood pressure.
Risk of Heart Attack or Stroke on Suddenly Stopping Clopidogrel: Stopping clopidogrel too early or suddenly can affect cardiovascular outcomes, increasing your risk of myocardial infarction (heart attack) or stroke. Make sure you take clopidogrel every day as directed by your doctor or pharmacist. Don't stop taking clopidogrel without talking to your doctor first, even if you feel well.
Low Platelet Count: Very rarely, taking clopidogrel can lead to a condition called thrombotic thrombocytopenic purpura (TTP). TTP is a serious bleeding disorder that can be potentially life-threatening. Get emergency medical help if you notice unusual bruising, excessive bleeding, dizziness, weakness, fatigue, or trouble breathing.
Allergic Reactions: A small number of people can be allergic to clopidogrel. The risk is higher if a person is allergic to antiplatelet agents such as prasugrel (Effient) and ticlopidine. You should stop taking clopidogrel and call your doctor immediately if you notice any signs or symptoms of an allergic reaction, such as hives, rash, or itching after taking this medicine. You should seek emergency medical help if you experience difficulty breathing or swallowing or swelling of the face, tongue, or throat.

What should I tell my doctor before starting clopidogrel (Plavix)?

Tell your doctor if you are allergic to clopidogrel (Plavix), active or inactive ingredients in clopidogrel tablets, other antiplatelet agents like ticlopidine or prasugrel (Effient), or any other drugs. Your pharmacy can provide you with a list of ingredients.

Give your doctor and pharmacist a complete list of all your medicines, including prescription and over-the-counter medications, vitamins, supplements, and herbal products. This can help avoid serious drug interactions.

Give your doctor a complete medical history. Specifically, tell your doctor if you have any bleeding disorders, history of major bleeding, bleeding in the brain, blood clot problems, gastric ulceration (stomach ulcer), or gastrointestinal hemorrhage. Also, tell your doctor if you have liver or kidney disease. Based on your medical history, your doctor will decide whether it is safe for you to take clopidogrel.

Tell your doctor if you are pregnant, could be pregnant, plan to become pregnant, or are breastfeeding.

What precautions should I take while on clopidogrel?

Keep all your appointments at your doctor’s office. Your doctor may order lab tests to check your bleeding risk.

Remember that you are at an increased risk of bleeding while taking clopidogrel. Be careful to avoid injuries and cuts. Call your doctor immediately if you have active bleeding that won’t stop.

If you’re having surgery, including dental surgery, tell your doctors that you take clopidogrel. You may need to stop taking this medication for a few days around the time of your surgery.

Tell your doctor if you become pregnant while taking clopidogrel.

What drugs can interact with clopidogrel (Plavix)?

Concomitant therapy with clopidogrel and other drugs can affect how the medications work and/or increase the risk of severe side effects. Your physician may choose a different medication, change the dose or frequency of your medicines, and/or monitor you carefully for side effects if there are known drug interactions between clopidogrel and your other drugs. There can be drug interactions between clopidogrel and other medications, such as:
Blood thinners (anticoagulants) such as warfarin (Coumadin, Jantoven)
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, naproxen (Aleve, Naprosyn), and ibuprofen (Advil, Motrin)
Other antiplatelet agents like cilostazol
Proton pump inhibitors like esomeprazole (Nexium) and omeprazole (Prilosec, Prilosec OTC, Zegerid)
Certain drugs used to treat HIV, such as etravirine (Intelence)
Diabetes medications such as repaglinide (Prandin, in Prandimet)
Certain opiate medications such as cough remedies containing codeine (Triacin-C, Tuzistra XR, and others) or hydrocodone (Hycodan, Tussicaps); pain medications containing codeine (Fioricet, Trezix), fentanyl (Duragesic, Actiq, Subsys, others), hydrocodone (Zohydro, Hysingla, Norco, Anexsia), morphine (Kadian, Duramorph), meperidine (Demerol), and oxycodone (Percocet, Roxicet, others)
Certain antidepressants such as selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac, Sarafem, Symbyax), citalopram (Celexa), escitalopram (Lexapro), sertraline (Zoloft), fluvoxamine (Luvox), paroxetine (Paxil) and selective serotonin/norepinephrine reuptake inhibitors (SNRIs) such as duloxetine (Cymbalta), desvenlafaxine (Pristiq, Khedezla), and venlafaxine (Effexor)

All possible drug interactions of clopidogrel are not included in this list. Give your doctor or pharmacist a complete list of your medications, including prescription drugs, over-the-counter medicines, dietary supplements, vitamins, and herbal remedies. Also, tell your healthcare providers if you smoke, drink alcohol, or use illegal drugs because some of these substances can cause serious health complications when used with prescription drugs.

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