What are the most common side effects of Plavix (clopidogrel)?

Most Common Side Effects of Plavix (Clopidogrel)

The most common side effects of Plavix (clopidogrel) include bleeding, bruising, stomach upset or pain, diarrhea, and headache. 1

Primary Side Effects

Clopidogrel's side effects can be categorized by frequency and severity:

Common Side Effects

• Bleeding and bruising: Most significant concern due to clopidogrel's antiplatelet mechanism
• Gastrointestinal issues:
  • Stomach upset or pain
  • Diarrhea
  • Nausea
• Neurological symptoms:
  • Headache
  • Dizziness
  • Fatigue

Less Common but Serious Side Effects

• Gastrointestinal bleeding: Particularly in patients with history of peptic ulcer disease 2
• Thrombotic Thrombocytopenic Purpura (TTP): A rare but serious blood clotting disorder that requires immediate hospitalization 1
• Allergic reactions: Including skin rashes 3

Risk Factors for Side Effects

Certain patient populations have increased risk of experiencing side effects:

• History of GI bleeding or peptic ulcer disease: 22% of patients with previous GI bleeding developed recurrent bleeding on clopidogrel 2
• Elderly patients
• Patients taking multiple antithrombotic medications
• Patients with high alcohol consumption
• Those using chronic steroids or NSAIDs 4

Minimizing Side Effect Risk

Proton Pump Inhibitor Use

• Gastric protection with proton pump inhibitors is recommended for patients at increased risk of GI bleeding while on antithrombotic therapy 4
• Note on drug interactions: While omeprazole and esomeprazole inhibit CYP2C19 and may reduce clopidogrel's active metabolite, definitive evidence of increased ischemic events or stent thrombosis with this combination has not been demonstrated 4

Dosing Considerations

• Standard dosing is 75 mg daily for maintenance therapy
• For acute coronary syndrome, a 300 mg loading dose followed by 75 mg daily is typically used 1

Special Populations

Renal Impairment

• No dosage adjustment is needed for patients with renal impairment, including those on hemodialysis 5
• Studies show clopidogrel inhibits ADP-induced platelet aggregation in hemodialysis patients similarly to non-uremic subjects 5

Pregnancy and Breastfeeding

• Limited data available on use during pregnancy
• It is not known if clopidogrel passes into breast milk 1

Drug Interactions

Important interactions to be aware of:

• NSAIDs: Increased bleeding risk 1
• Warfarin: Increased bleeding risk 1
• SSRIs/SNRIs: May increase bleeding risk 1
• Strong CYP2C19 inducers (rifampin, carbamazepine): May increase clopidogrel's active metabolite levels 1
• Strong CYP2C19 inhibitors (omeprazole): May decrease clopidogrel's effectiveness 4, 1

Monitoring Recommendations

• Regular monitoring for signs of bleeding
• No routine laboratory monitoring is required (unlike warfarin)
• If undergoing surgery, clopidogrel should typically be stopped ≥5 days before the procedure to reduce bleeding risk 4

Remember that while side effects can occur, clopidogrel has demonstrated significant benefits in reducing cardiovascular events in patients with established cardiovascular disease, and the benefit-risk profile is generally favorable for indicated patients.