What other medications are in the same antiplatelet class as Plavix (clopidogrel) and Effient (prasugrel)?

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P2Y12 Receptor Antagonists in the Same Class as Plavix and Effient

Plavix (clopidogrel) and Effient (prasugrel) belong to the P2Y12 receptor antagonist class, and the other medications in this class are ticagrelor (Brilinta) and cangrelor (Kengreal). 1

Complete List of P2Y12 Receptor Antagonists

Oral Agents

  • Clopidogrel (Plavix) – a thienopyridine prodrug requiring CYP2C19-mediated conversion to its active metabolite, causing irreversible P2Y12 receptor inhibition with a maintenance dose of 75 mg once daily 1
  • Prasugrel (Effient) – a third-generation thienopyridine prodrug with more rapid and complete conversion to active metabolite than clopidogrel, causing irreversible P2Y12 receptor inhibition with a maintenance dose of 10 mg once daily 1, 2
  • Ticagrelor (Brilinta) – a cyclopentyl-triazolopyrimidine that directly and reversibly inhibits the P2Y12 receptor without requiring metabolic activation, dosed at 90 mg twice daily 1

Intravenous Agent

  • Cangrelor (Kengreal) – a direct-acting, reversible P2Y12 antagonist administered as continuous IV infusion with rapid onset and offset of action 2, 3, 4

Key Mechanistic Differences Within the Class

Irreversible vs. Reversible Inhibition

  • Clopidogrel and prasugrel irreversibly bind to the P2Y12 receptor, meaning platelet function recovery requires generation of new platelets over 5–7 days after drug discontinuation 1, 5
  • Ticagrelor and cangrelor reversibly inhibit the P2Y12 receptor, with platelet function returning within 3–5 days for ticagrelor and within hours for cangrelor after drug cessation 1, 5, 3

Prodrug vs. Active Drug

  • Clopidogrel and prasugrel are prodrugs requiring hepatic CYP450-mediated conversion to active metabolites, with prasugrel achieving more rapid and consistent activation than clopidogrel 1, 3
  • Ticagrelor and cangrelor are active compounds that do not require metabolic conversion, eliminating variability from genetic polymorphisms in metabolizing enzymes 1, 5, 3

Comparative Pharmacology Summary

Agent Class Mechanism Onset Maintenance Dose
Clopidogrel Thienopyridine Irreversible, indirect 30–60 min 75 mg daily [1]
Prasugrel Thienopyridine Irreversible, indirect 30 min 10 mg daily [1]
Ticagrelor Cyclopentyl-triazolopyrimidine Reversible, direct 1.5–3 hours 90 mg twice daily [1]
Cangrelor ATP analog Reversible, direct Immediate (IV) Continuous infusion [2,3]

Clinical Guideline Recommendations for Class Members

Acute Coronary Syndrome

  • All three oral P2Y12 inhibitors (clopidogrel, prasugrel, and ticagrelor) receive Class I recommendations from ACC/AHA guidelines for patients with unstable angina and NSTEMI 1
  • Prasugrel and ticagrelor are now the preferred first-line agents for ACS in the UK, with clopidogrel reserved for patients on anticoagulant therapy or with high bleeding risk 1

Post-PCI Management

  • Clopidogrel remains the first choice for elective PCI, with 6 months of dual antiplatelet therapy recommended 1
  • For ACS patients undergoing PCI, prasugrel or ticagrelor are preferred over clopidogrel due to superior efficacy in reducing major adverse cardiovascular events 1

Important Clinical Caveats

Drug-Drug Interactions

  • Ticagrelor is contraindicated with strong CYP3A4 inhibitors (itraconazole, ketoconazole, clarithromycin, ritonavir) and discouraged with potent CYP3A4 inducers (carbamazepine, rifampicin, phenytoin) 6, 3
  • Clopidogrel efficacy is reduced by strong CYP2C19 inhibitors (omeprazole, esomeprazole), which should be avoided 1, 3

Genetic Considerations

  • Approximately 30% of individuals carry a CYP2C19 loss-of-function allele, resulting in reduced clopidogrel activation and higher rates of cardiovascular events, but this does not affect prasugrel or ticagrelor efficacy 1, 7
  • Prasugrel and ticagrelor provide consistent platelet inhibition regardless of CYP2C19 genotype, making them preferred alternatives in known poor metabolizers 1, 7

Bleeding Risk Profile

  • Prasugrel carries the highest bleeding risk, with contraindications including prior stroke/TIA, age ≥75 years (except high-risk situations), and body weight <60 kg 1
  • Ticagrelor increases bleeding risk compared to clopidogrel but less than prasugrel, with no absolute contraindication for prior stroke 1
  • Clopidogrel has the lowest bleeding risk among the oral P2Y12 inhibitors, making it preferred in patients with high bleeding risk 1

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Research

New P2Y12 blockers.

Journal of thrombosis and haemostasis : JTH, 2009

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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