Clopidogrel dosing

Investigators n Patients Clopidogrel dose Definition of clopidogrel Time Incidences (96)... 

For patients with NSTE ACS, clopidogrel started on the first day of hospitalization as a 300 to 600 mg loading dose and followed the next day by 75 mg orally per day is recommended for most patients.2 Although the use of aspirin in ACS is the mainstay of antiplatelet therapy, morbidity and mortality following an ACS remain high. Clopidogrel, administered as a 300 mg loading dose followed by 75 mg once daily for 9 to... 

Clopidogrel is recommended for patients with an aspirin allergy. A 300- to 600-mg loading dose is given on the first hospital day, followed by a maintenance dose of 75 mg daily. It should be continued indefinitely. 

For patients undergoing primary PCI, clopidogrel is administered as a 300-to 600-mg loading dose followed by a 75 mg/day maintenance dose, in combination with aspirin 325 mg once daily, to prevent subacute stent thrombosis and long-term cardiovascular events. 

Because of the potential increased risk for bleeding with combination antiplatelet therapy, a low dose of aspirin (75 to 100 mg/day) is recommended for maintenance therapy with clopidogrel. 

All antiplatelet drugs increase the risk of bleeding. Even at the low ASA doses used to inhibit platelet function (100 mg/d), ulcerogenic and bronchocon-strictor (aspirin asthma) effects may occur. Ticlopidine frequently causes diarrhea and, more rarely, leukopenia, necessitating cessation of treatment Clopidogrel reportedly does not cause hematological problems. 

Recent Ml, recent stroke, or established peripheral arterial disease The recommended dose of clopidogrel is 75 mg once daily with or without food. 

Acute coronary syndrome For patients with acute coronary syndrome (unstable angina/non-Q-wave Ml), initiate clopidogrel with a single 300 mg loading dose and then continue at 75 mg once daily. Initiate and continue aspirin (75 to 325 mg once daily) in combination with clopidogrel. 

Dose-dependent inhibition of platelet aggregation can be seen 2 hours after single oral doses of clopidogrel. Platelet aggregation and bleeding time gradually return to baseline values after treatment is discontinued, generally in about 5 days. Pharmacokinetics ... 

Tenecteplase (TNKase) [Thrombolytic/Recombinant Tissue Plasminogen Activator] Uses Restore perfusion i mortality w/ AMI Action Thrombolytic TPA Dose 30-50 mg see Table III-l Caution [C, ], T Bleeding w/ NSAIDs, ticlopidine, clopidogrel, GPIIb/IIIa antagonists Contra Bleeding, CVA, major surgery (intracranial, intraspinal) or trauma w/in... 

Clopidogrel is indicated for prevention of vascular ischaemic events in patients with symptomatic atherosclerosis. It is also used, along with aspirin, for the prevention of thromboembolism after placement of an intracoronary stent. Platelet inhibition can be demonstrated two hours after a single dose of oral clopidogrel, but the onset of action is slow, so that a loading-dose is usually administered. Although rare, severe neutropenia and also thrombotic thrombocytopenic purpura may occur. 

Clopidogrel has fewer adverse effects than ticlopidine and is rarely associated with neutropenia. Thrombotic thrombocytopenic purpura associated with clopidogrel has been reported. Because of its superior side effect profile and dosing requirements, clopidogrel is preferred over ticlopidine. The antithrombotic effects of clopidogrel are dose-dependent within 5 hours after an oral loading dose of 300 mg, 80% of platelet activity will be inhibited. The maintenance dose of clopidogrel is 75 mg/d, which achieves maximum platelet inhibition. The duration of the antiplatelet effect is 7-10 days. 

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