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Clopidogrel
Clopidogrel is a blood-thinning drug that can be used to prevent a heart attack or stroke and for the treatment of cerebral circulatory disorders of the limbs (peripheral vascular disease). He is considered a well-tolerated, with the effectiveness with which other “blood thinners” is comparable. Clopidogrel is, however, considerably more expensive, which is why the active ingredient is used only as a means of second choice. Here you can read everything about Clopidogrel.
How Clopidogrel works
Mechanism of Action
The human body has an efficient system for closing wounds, which is activated immediately when minor injuries occur. Platelets (thrombocytes) are deposited thereby clots together and close the open spot, so no blood can escape. Certain endogenous substances are for this wound closure (including the so-called adenosine phosphate, ADP) requires that indicate the violation of the platelets and stimulate them so, to aggregate.
In patients who have already suffered or suffer from circulatory disorders in the limbs, often there is a risk that blood clots (thrombi) on the inner wall of the blood vessels. If the blood flow entrains this, they can block blood vessels in the brain or in the heart of a so-called embolus, thus causing a (renewed) heart attack or stroke.
In order to reduce this risk, Clopidogrel can be given. As a so-called platelet aggregation inhibitors preventing rapid aggregation of platelets by blocking the signal transduction of the neurotransmitter Adenosinphophat to the platelets. So too rapid blood clotting is inhibited. This reduces the risk of a heart attack or stroke is reduced efficiently by Clopidogrel.
Pharmacokinetics and metabolism of Clopidogrel
After taking over her mouth Clopidogrel is taken only to about 50 percent from the intestine into the blood. Then the drug substance in the liver must be activated before it can exert its effect. The reduction takes place in the liver; the degradation products are excreted via the kidneys and the chair.
When is Clopidogrel used?
The fields of application (indications) of Clopidogrel are:
- a seven to 35 days of past heart attack
- a stroke, which dates back seven days to six months
- circulatory disorders of the limbs (peripheral vascular disease)
- acute coronary syndrome (in combination with)
How Clopidogrel is used
The active ingredient Clopidogrel acts relatively long and therefore needs to be taken only once a day. This is usually done on tablets and with or without food. The usual daily dose for adults is 75 milligrams. Often, the treatment with a unique “loading dose” of 300 milligrams of Clopidogrel is started and then continued with 75 milligrams daily.
It may be useful to combine Clopidogrel with other drugs in order to intensify the effect. Often there is a combination with acetylsalicylic acid. The two drugs have different points of attack on the anticoagulants which the clustering of platelets delayed even more efficiently. This drug combination is often prescribed patients after the onset of a so-called “stents”. A stent is a small tube which the unimpeded blood flow ensures in narrow blood vessels when a patient has an increased risk of heart attack or stroke.
What are the side effects of Clopidogrel?
Often (that is, at one to ten percent of patients) calls Clopidogrel side effects such as bruising, bleeding in the gastrointestinal tract and general gastrointestinal symptoms such as, dizziness, eye bleeding, gastrointestinal ulcers, skin lesions, blood in urine and prolonged bleeding time.
What should I watch for while taking Clopidogrel?
Contraindications
Patients who suffer from severe hepatic impairment or acute pathological bleeding, Clopidogrel should not take.
Limitations
The Clopidogrel effect lasts for several days. Therefore, elective surgery (including dental surgery) is previously discontinued the drug a week in consultation with the doctor.
Patients who are suffering from kidney or liver problems, should keep before taking Clopidogrel consultation with the doctor, because to date, very few data were collected.
Some people are so-called slow metabolizers of CYP2C19. For them, the active ingredient in the liver is slowed only enabled, significantly reducing its effect. Use of certain tests can predict the efficacy of Clopidogrel.
Interaction
The effects and side effects of Clopidogrel are other blood-thinning agents (such as aspirin, heparin, abciximab, eptifibatide, tirofiban) strengthened. The same applies to analgesics such as Ibuprofen, Naproxen, Diclofenac, Indomethacin, Meloxicam, piroxicam, phenylbutazone, celecoxib, Etoricoxib, parecoxib and.
drugs which reduce the activation of Clopidogrel, reduce the blood-thinning effect. These drugs include, for example, Omeprazole (gastric acid inhibitors), Fluoxetine and moclobemide (antidepressants), voriconazole and Fluconazole (for fungal infections), ticlopidine (also a platelet inhibitor), Ciprofloxacin and Chloramphenicol (antibiotics), cimetidine (to treat heartburn and peptic ulcers) and Carbamazepine (for epilepsy).
Overdose
In an overdose of Clopidogrel may be a strong tendency to bleed. Therefore, always a doctor should be consulted if the suspect an overdose is.
So far, no known antidote (antidote) at a poisoning with Clopidogrel. One way of treatment is the administration of platelet-canned to restore blood clotting.
Parental
The active ingredient Clopidogrel should not be used in children and adolescents, since efficacy has not been established.
Pregnancy and lactation
Pregnant and lactating women should only take the active substance Clopidogrel after the doctor has carefully evaluated the benefits and risks of treatment up to today.
How to get Clopidogrel
Because of a “blood-thinning” therapy a regular examination by a doctor is recommended, drugs with Clopidogrel are prescription.
Since when Clopidogrel is known?
Clopidogrel is not so long known as the active ingredient. He picks at another point in the blood clotting, a blood-thinning drugs than the so often used as acetylsalicylic acid (ASA). Gastrointestinal ulcers as side effects of treatment occur by Clopidogrel on rarer than under ASA. In studies but was then found that the drug has a same efficacy as his “colleagues”, but at the same time is much more expensive. Therefore Clopidogrel is used only as a means second choice, as when compared to the means of choice incompatibilities are to be expected.
