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Clopidogrel, sold under the brand name Plavix among others, is an antiplatelet medication used to reduce the risk of heart disease and stroke in those at high risk. [10] It is also used together with aspirin in heart attacks and following the placement of a coronary artery stent ( dual antiplatelet therapy ). [ 10 ]
Prasugrel is a member of the thienopyridine class of ADP receptor inhibitors, like ticlopidine (trade name Ticlid) and clopidogrel (trade name Plavix). These agents reduce the aggregation ("clumping") of platelets by irreversibly binding to P2Y 12 receptors. Prasugrel inhibits platelet aggregation more rapidly, more consistently, and to a ...
Metabolism of ticlopidine, clopidogrel and prasugrel to an active metabolite. Clopidogrel is a prodrug that is metabolized by two pathways. In one of the pathway most of the dose of clopidogrel (85%) is hydrolyzed by esterases to an inactive carboxylic acid derivate and rapidly cleared via glucoridination followed by renal excretion.
Often a combination of aspirin plus an ADP/P2Y inhibitor [7] (such as clopidogrel, prasugrel, ticagrelor, or another) is used to obtain greater effectiveness than with either agent alone. This is known as "dual antiplatelet therapy" (or DAPT).
Side effects [23] Increased bleeding risk; Rash (Clopidogrel) Dual antiplatelet therapy with aspirin for a reduction of risk of major adverse cardiac events for all acute coronary syndrome patients [24] An image of clopidogrel tablet package (Plavix) Caution. Metabolism of P2Y12 inhibitors requires CYP450 enzymes → potential drug interactions
However, because of its rare but serious side effects of neutropenia and thrombotic microangiopathy it was primarily used in patients in whom aspirin was not tolerated, or in whom dual antiplatelet therapy was desirable. With the advent of newer and safer antiplatelet drugs such as clopidogrel and ticagrelor, its use remained limited.
Consistently with its reversible mode of action, ticagrelor is known to act faster and shorter than clopidogrel. [35] This means it has to be taken twice instead of once a day which is a disadvantage in respect of compliance, but its effects are more quickly reversible which can be useful before surgery or if side effects occur. [24] [36]
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