Clopidogrel

Non-ST-elevation ACS, including medical management or coronary revascularization, and medically managed STEMI: reduce MI/stroke with aspirin. Recent MI, recent stroke or established PAD: reduce MI/stroke.

AHA/ASA recommends short-term dual antiplatelet therapy only in selected patients, such as early minor stroke/high-risk TIA or severe symptomatic intracranial stenosis. Routine long-term DAPT is not recommended for secondary stroke prevention. The indication-specific duration and stroke mechanism require clinician review.

May take with or without food. ACS uses aspirin as labeled; PCI, switching from another P2Y12 inhibitor and DAPT duration require an individualized cardiology/neurology plan. This profile supplies no universal switch, 600 mg loading or fixed DAPT-duration rule.

Hepatic impairment and older age require no label dose adjustment. Moderate/severe renal experience is limited; individualize risk assessment. For surgery with major bleeding risk, interrupt 5 days beforehand when possible, then restart once hemostasis is achieved under the treating team.

Active pathological bleeding, including peptic-ulcer or intracranial bleeding; hypersensitivity to clopidogrel or product components.

Patients with two nonfunctional CYP2C19 alleles form less active metabolite and have reduced platelet inhibition. Tests can identify poor metabolizers; consider another P2Y12 inhibitor. The label does not establish a universal dose escalation to overcome this.

Bleeding, bruising, epistaxis and hematoma are prominent; itching is reported. Serious postmarketing allergy, skin, blood, liver and lung disorders include insulin autoimmune syndrome with severe hypoglycemia. Overdose may cause bleeding; urgent medical assessment is required and platelet transfusion may restore clotting.

• Avoid omeprazole/esomeprazole; omeprazole reduces effect even 12 hours apart. Other listed PPIs had less effect; select gastroprotection with the prescriber.
• Avoid strong CYP2C19 inducers such as rifampin.
• Opioids delay/reduce absorption; consider a parenteral antiplatelet in ACS requiring opioids.
• NSAIDs, warfarin, other antiplatelets and SSRIs/SNRIs increase bleeding risk.
• Avoid repaglinide. If unavoidable, its label-directed start is 0.5 mg before meals, maximum 4 mg/day with more glucose monitoring.

Available pregnancy reports have not identified a major-birth-defect/miscarriage signal; emergency MI/stroke treatment should not be withheld solely for fetal concerns. Avoid neuraxial blockade during use; when possible stop 5–7 days before delivery/blockade. Milk data are limited; individualize breastfeeding benefit/risk.

Pediatric safety/effectiveness is not established. A neonatal/infant shunt trial showed no clinical benefit. Older adults do not need an age-only adjustment; bleeding context and comorbidities still matter.

The active metabolite binds platelet P2Y12 ADP receptors irreversibly, suppressing activation/aggregation for the platelet lifespan.

Activation

Hepatic CYP enzymes, principally CYP2C19; much drug becomes inactive metabolites.

Half-lives

Parent approximately 6 hours; active metabolite about 30 minutes.

Elimination

Radiolabeled dose: approximately 50% urinary and 46% fecal recovery over 5 days.

Platelet effect

Steady inhibition after 75 mg/day by days 3–7; recovery generally about 5 days after stopping.

• Evaluate blood loss, bruising and unexplained anemia; CBC/platelets and organ tests follow clinical findings.
• Assess TTP symptoms: low platelets/hemolysis, neurologic changes, renal dysfunction and fever.
• Review CYP2C19 results when available and medicines affecting activation/bleeding.
• Check adherence, ischemic symptoms and repaglinide-related hypoglycemia if combination unavoidable.

Read the Medication Guide. Do not stop independently. Tell clinicians/dentists before procedures; report prolonged bleeding or blood in stool/urine. Seek urgent help for unexplained fever with neurologic symptoms, weakness or unusual bruising. Review OTC acid reducers, NSAIDs and supplements.

Appearance

Pink round biconvex film-coated tablet.

Imprint

75 / 1171.

Manufacturer

Sanofi-aventis U.S. LLC.

Example NDC

0024-1171-90 · 90 tablets.

U.S. status

Prescription medicine.

Selected oral tablets

75 mg and 300 mg.

300 mg appearance

Pink oblong, imprinted 300 / 1332; distinct loading strength.

Store at 25°C; excursions 15–30°C. Keep the prescribed formulation/strength identified and dispense the Medication Guide.