Cardiovascular diseases account for one-fourth of annual fatalities in the US, with a staggering 650,000 individuals succumbing to one of the different types of cardiovascular conditions. Ranked as the number condition among all reasons for death in the US, heart diseases are also the leading cause of death globally. There are different types of conditions within cardiovascular disease and medications are prescribed on the basis of the types and other factors. Clopidogrel is one of the various medications recommended in the treatment of multiple conditions including peripheral vascular disease, CAD, and cerebrovascular disease among others. Subsequent sections offer detailed insights into the drug, including the side effects of clopidogrel.

Overview of the antiplatelet agent clopidogrel

Belonging to the category of a prodrug or platelet inhibitor, clopidogrel is effective in preventing blood clot formation in patients with various cardiovascular conditions. The medication is known to be effective in reducing the risk of myocardial infarction among patients. It is also effective in treating/managing stroke and peripheral arterial diseases, with proven efficacy that is ranked higher than aspirin.

Mechanism of action

The mechanism of action of clopidogrel is attributed to the irreversible binding action of the platelet inhibitor to specific ADP receptors. As a consequence of this binding action, the ADP is inhibited from binding to chemoreceptors and thereby prevents the activation of platelets and the accumulation of platelets through aggregation.  This is essentially how the medication works, delivering the desired and proven outcomes.

The ideal dosage of clopidogrel

Ideally, the medication, available as tablets, is taken in strengths of 75 mg, once every day. Clopidogrel is intended to be taken every day at the same time, and it is essential to stick to a routine to follow a schedule. The medication can be taken either with food or without food. The actual strength may differ from condition to condition and will be as per the evaluation of specialists. In certain circumstances, the specialist may recommend a higher one-time dose of 300 mg or 600 mg, depending on the condition. Various factors will determine the actual dosage of the prescription only medication. For instance, the age, the actual condition being treated, other existing conditions, and use of other medications. The medication is often prescribed as a combination medication with aspirin in low doses, or it may also be prescribed to replace aspirin.

Simple precautions about the use of the medication

Side effects of the medication may be experienced by individuals, including certain common undesirable outcomes that are not a reason for concern. While consumption of liquor while on the medication is permitted, it is advisable to avoid overindulgence. Excessive consumption of liquor while on clopidogrel may trigger irritation in the stomach, and in certain instances, individuals who consume lesser quantities are also known to experience some kind of stomach upset. Patients scheduled to undergo any surgery, including dental procedures, are expected to avoid the antiplatelet agent for a short period, prior to the procedure. This is to be carried out with consultation of the surgeon, to prevent likely abnormal bleeding during the procedure.

Categories of individuals who are unsuitable to take the medication

While it is regarded as relatively safe, there are certain categories of users who are not to take the medication. This is because of the possible side effects of clopidogrel that may be experienced by certain users. For instance, individuals who have had some kind of allergic reaction in the past to clopidogrel or any other medication are not to use the antiplatelet agent. Patients diagnosed with stomach ulcers, or patients who have recovered from stomach ulcers are also not to take the medication. Individuals with a history or diagnosis of brain hemorrhage, are also unsuitable to use clopidogrel. Other conditions that render the patient unsuitable include individual liver complications, renal impairment, and patients with bleeding disorders. Women planning a pregnancy or pregnant women/nursing mothers are also to avoid the medication. The drug can be consumed only when the doctor determines that it is safe for use as treatment.

Commonly reported side effects of clopidogrel

It is time to look at the commonly reported undesirable effects of the medication. Patients on the medication are known to experience slightly higher than normal bleeding. For instance, individuals with nosebleeds may experience more bleeding. Similarly, women may have to put up with heavy periods, when compared to pre-medication periods. Other conditions include more than usual bleeding from bruises or bleeding from the gums. Other likely effects that may be experienced by patients include pain in the stomach, and possible diarrhea when on the medication. Individuals are also known to experience heartburn and possible indigestion as a result of the mechanism of action of the medication.

In addition to the above, there is also the possibility of patients undergoing adverse or stronger undesirable effects. Some of the outcomes reported and recorded include blood in urine, blood in feces, and traces of blood in vomit. Patients have reported coughing up blood; however, it is necessary to add that the rate of incidence of such effects is rare and not common. It may be necessary to seek medical assistance in the event these outcomes persist or are intense in nature. Other effects considered adverse or serious include symptoms of liver complications, such as a change in skin complexion to yellow, and a change in the color of the whites of the eye – to a yellowish hue. Other indications of stronger effects include fatigue, and tell-tale signs of infections, like a sore throat or spike in temperature.

Another condition that patients need to be aware of is the possibility of patients ending up with TTP as a result of clopidogrel. Acronym for thrombotic thrombocytopenic purpura refers to the condition wherein blood clots form throughout the body. The formation of blood clots in this condition could also extend to the small blood vessels. There are clear symptoms that are indicative of this condition, and patients are advised to learn more about this condition, recognize the symptoms, and seek suitable remedial action.

The need for medical intervention when allergic reactions are experienced

There is the possibility of individuals experiencing anaphylaxis, a serious allergy, that may quickly aggravate a medical emergency. Patients and caregivers are advised to seek medical intervention at the earliest on the observance of certain indications of allergies. This includes an outbreak of rashes, that are inflamed, and reddish in appearance along with the formation of blisters on the skin. The skin is also known to peel at times, indicating allergic reactions. Any difficulty in breathing, wheezing, or an abnormal tightening feeling in the chest is to be considered as an indication of serious effects.

Similarly, individuals experiencing any inflammation in the face, on the lips, the tongue, or throat are to immediately seek medical intervention. While it may appear trivial, certain allergies have the dubious distinction of swiftly aggravating a serious condition.

Remedies to mitigate and manage certain undesirable outcomes

Patients who experience certain outcomes are advised to stop panicking and follow simple instructions to mitigate or prevent side effects from causing serious problems. For instance, individuals who observe or experience more bleeding are advised to follow simple precautions, like wearing protective gear to avoid injuries. Individuals in hazardous work environments or in tasks that involve sharp objects are to remain alert and reduce the risk of injuries. Apart from the workplace or routine tasks at home, it is also necessary to take precautions in performing actions such as brushing and using dental floss.

As outlined earlier, there is the possibility of patients experiencing diarrhea, and this is best handled by consuming large amounts of liquids. This is necessary to avoid dehydration, and it is also important to check for signs of dehydration. For instance, urine that has a strong smell, that is unusual, or if the frequency of visits to the washroom comes down, then it is necessary to look at options to manage the dehydration.

Patients experiencing pain in the stomach are advised to take smaller portions of food and makeup with an increase the frequency of meals. Normal pain relief actions such as the use of moderate heat on the stomach will help ease the pain. If the pain is uncontrollable, persistent, or intense, it is necessary to receive medical assistance. Other undesirable effects of clopidogrel include heartburn and indigestion. Patients experiencing symptoms of indigestion or heartburn are advised to try taking the medication immediately either before or after a meal. This should help reduce the condition; in the event that it persists, it is most likely an indication of a stomach ulcer. It may then be necessary to be evaluated or to look at alternate drugs.

Interactions with other medications

In addition to the undesirable outcomes of the medication, there is also the likelihood of the drug interacting with other medications or substances. This is not uncommon for medications and the type of interactions could differ. For instance, depending on the interaction, either of the medications or substances could turn more potent, or could have lesser efficacy, or could trigger stronger side effects. Patients on other medications for preventing the formation of blood clots, are to avoid taking the two together. This includes drugs such as warfarin, ticagrelor, aspirin, and edoxaban. This is not an exhaustive or comprehensive list of drugs that interact but is more of a broad reference of the possible interactions.

Other medications or categories of medications that could interact include NSAIDs or non-steroidal anti-inflammatory drugs. It is also necessary to steer clear of certain SSRIs or selective serotonin reuptake inhibitors. The next category of medications includes PPIs or proton pump inhibitors that are recommended to mitigate GERD. Clopidogrel can be combined with antacids and will not cause interactions, but cannot be used in combination with PPIs.

Most users tend to assume that herbal remedies or alternative medications and supplements will not have any effect on medications. However, this is a wrong assumption, as the possibility of interactions cannot be ruled out. Clopidogrel is likely to interact with certain herbal remedies that have some outcome on the blood. As the mechanism of action of the drug prevents aggregation of platelets, this may interact with herbal products that work on the blood in some way.

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