Clopidogrel Bisulfate (Plavix) Nursing Implications |Patient Teachings

Introduction

In this article, you’ll learn about Clopidogrel Bisulfate (Plavix) nursing implications and patient teachings. Also, its dosage, indication, side effects.

Generic Name: Clopidogrel Bisulfate

Brand Name(s): Plavix

Clopidogrel Class and Category

Pharmacologic class: Thienopyridine derivative

Therapeutic class: Platelet aggregation inhibitor

Pregnancy category: B

Clopidogrel Dosage

Adults: PO: Loading dose 300mg; then 75mg/day.

Clopidogrel Pharmacokinetics and Pharmacodynamics

RouteOnsetPeakDuration
PO1 – 2 hrs3 – 7 days5 days
Clopidogrel pharmacokinetics & pharmacodynamics

Absorption: Clopidogrel absorbs rapidly.

Distribution: Protein binding is 94 – 98 percent.

Metabolism: Hepatic

Half-life: 8 hours

Excretion: Excretes equally through renal and fecal routes.

Clopidogrel Mechanism of Action

Clopidogrel inhibits platelet activation and aggregation by the irreversible binding of its active metabolite (GPIIb/IIIa) to platelet P2Y12 adenosine diphosphate (ADP) receptors.

Clopidogrel’s therapeutic effect is to prevent recurring MI or stroke and vascular death.

What are the indications of Clopidogrel?

Clopidogrel indications include:

  • To prevent recurrent myocardial infarction (MI)
  • To lower the risk of thrombotic events such as MI, stroke, and vascular death in high risk patients with peripheral arterial disease (PAD).
  • To lower the risk of MI and stroke in patients with acute coronary syndrome (such as unstable angina or non-ST-elevation myocardial infarction).

Off-label uses include:

  • Cardiac surgery
  • Kawasaki disease
  • Stable coronary artery disease
  • Initial treatment of ACS

What are the contraindications of Clopidogrel?

The contraindications of Clopidogrel are:

  • Hypersensitivity to clopidogrel and its components.
  • Active bleeding such as peptic ulcers and intracranial bleeding.

Caution: hepatic impairment, renal impairment, patient with risk of bleeding (e.g.; trauma, surgery), neutropenia.

Clopidogrel Interactions

  • Aspirin and Warfarin increases risk of bleeding.
  • CYP2C19 inhibitors (e.g.; omeprazole, pantoprazole, esomeprazole) decreases the effectiveness of clopidogrel.
  • NSAIDs, serotonin norepinephrine reuptake inhibitors (SNRIs), selective serotonin reuptake inhibitors (SSRIs) may increase the risk of GI bleeding.
  • CYP3A4 inhibitors (e.g.; atorvastatin, simvastatin, cerivastatin) decreases the effectiveness of clopidogrel.
  • CYP2C8 inhibitors exposure may increase risk of hypoglycemia.

Lab interactions

  • Clopidogrel may increase LFTs, total cholesterol, uric acid levels, and nonprotein nitrogen (NPN).
  • Clopidogrel may decrease neutrophil count and platelet count.

Herbal/food interactions

  • Herbals with anticoagulant/antiplatelet properties can increase risk of bleeding when taken with clopidogrel. Examples include garlic, ginger, omega-3 fatty acid, and ginkgo biloba.
  • Grapefruit products may decrease clopidogrel’s effect.
  • Glucosamine supplements can increase risk of bleeding.

What are clopidogrel side effects?

Clopidogrel side effects / adverse reactions include:

  • Abdominal pain
  • Flulike symptoms
  • Dizziness
  • Epistaxis
  • Headaches
  • Arthralgia
  • Fatigue
  • Chest pain
  • Diarrhea
  • Hypertension
  • Bronchospasm
  • Thrombotic thrombocytopenic purpura (TTP)

Life-threatening adverse effects:

  • Agranulocytosis
  • Aplastic anemia
  • Thrombocytopenia
  • Anaphylaxis
Black Box Warning!
Anti-platelet effect is reduced in patients with two loss-of-function alleles of the CYP2C19 gene.
Concomitant use of CYP2C19 inhibitors (such as omeprazole, esomeprazole, pantoprazole) with clopidogrel is not recommended.
Clopidogrel’s Warning!

Clopidogrel Bisulfate (Plavix) Nursing Implications [Nursing Considerations]

Clopidogrel Bisulfate (Plavix) nursing implications are divided into nursing assessment, interventions, and evaluation. 

Clopidogrelnursing assessment

  • Obtain comprehensive medical history including hypersensitivity and risk for bleeding (such as trauma, thrombotic thrombocytopenic purpura).
  • Determine CYP2C19 allele. Because CYP2C19 poor metabolizers require another platelet inhibitor to reduce the risk of adverse cardiac events.
  • Obtain baseline CBCs, LFTs, RFTs, lipids, PT, PFA.

Clopidogrel nursing diagnosis

  • Risk for bleeding (side effect)
  • Risk for decreased tissue perfusion (indication)

Clopidogrel nursing interventions/ actions

  • Monitor platelet count periodically for early detection of thrombocytopenia.
  • STOP clopidogrel 5 days before elective surgery with a high risk of bleeding.
  • Monitor patient who take aspirin for bleeding. Because concomitant use increases risk of bleeding.
  • Monitor for allergic reactions especially at the beginning of the treatment. Because severe anaphylactic reaction such as angioedema may occur.
  • Observe for signs and symptoms of hepatic insufficiency during clopidogrel therapy.

Evaluation

Evaluate the effectiveness of clopidogrel:

  • For absence of stroke or MI
  • For absence of adverse effects.

Pregnancy/breastfeeding considerations for clopidogrel

  • It is unknown whether clopidogrel bisulfate (Plavix) can cause fetal damage. Use only with physician’s direction during pregnancy.
  • It is unknown whether clopidogrel bisulfate excretes via breastmilk. Use only with physician’s direction during lactation.
  • Ideally clopidogrel should be stopped at least 5 to 7 days before labor. Because it can increase risk of maternal bleeding.

What is the patient teaching for Clopidogrel?

The nursing patient teaching for clopidogrel bisulfate (Plavix) should include the following points.

  • Instruct the patient to continue taking clopidogrel as recommended and not to stop abruptly without consulting a doctor.
  • Teach the patient adverse effects of clopidogrel such as:
    • being prone to bruises and bleeding
    • taking longer than usual to stop the bleeding
    • purple skin patches
    • any unanticipated, prolonged, or excessive bleeding
    • blood in the stool or urine
    • neurologic changes
  • Advise the patient to seek immediate medical attention if any of the above-mentioned adverse events or symptoms are observed.
  • Instruct patient to do periodic blood work as advised.
  • Instruct the patient to inform physicians and dentists that they are taking clopidogrel. Because surgery or dental procedures increases risk of bleeding.
  • Instruct patient to avoid proton pump inhibitors (PPIs) such as omeprazole or esomeprazole. Because it reduces effectiveness of clopidogrel.
  • Advise the patient to avoid using NSAIDs, including OTC drugs, while taking clopidogrel due to the risk of bleeding.
  • Alert the patient that clopidogrel may cause hypoglycemia. Teach the patient signs and symptoms of hypoglycemia and how to treat it.
  • Also instruct the patient to notify prescriber about hypoglycemia.

Treatment of Overdose

Platelet transfusion may be needed in case of clopidogrel overdose.

Conclusion

You learned about clopidogrel bisulfate (Plavix) nursing implications and patient teaching in this article. In addition, you’ve learned about clopidogrel’s mechanism of action, pharmacokinetics, dosage, indications, contraindications, and side effects.

Recommended Readings & Reference

FDA Clopidogrel Bisulfate (Plavix) information

Kee, J., Hayes, E., & McCuistion, L. (2015). PHARMACOLOGY A Patient-Centered Nursing Process Approach (8th ed.). Elsevier Inc/Saunders.

Kizior, R., & Hodgson, K. (2021). SAUNDERS NURSING DRUG HANDBOOK 2021. Elsevier Inc.

Jones & Bartlett Learning. (2021). Nurse’s Drug Handbook (20th ed.). Jones & Bartlett Learning, LLC.

Skidmore-Roth, L. (2021). MOSBY’S 2021 NURSING DRUG REFERENCE (34th ed.). Elsevier Inc.

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