Usual Adult Dose for Acute Coronary Syndrome

Unstable Angina (UA)/Non-ST-Elevation Myocardial Infarction (NSTEMI):

• Loading dose: 300 mg orally once
• Maintenance dose: 75 mg orally once a day
• Duration of therapy: Optimal duration unknown.

• Loading dose: 300 mg orally once (OPTIONAL)
• Maintenance dose: 75 mg orally once a day, with or without thrombolytics
• Duration of therapy: Optimal duration unknown.

• Administer this drug in combination with aspirin 75 mg to 325 mg orally once a day.
• The benefit of this drug for patients who undergo primary percutaneous coronary intervention is unknown.

Usual Adult Dose for Ischemic Stroke

75 mg orally once a day

Uses: Prevention of atherothrombotic events in patients with a history of recent myocardial infarction, recent stroke, or established peripheral arterial disease.

Usual Adult Dose for Myocardial Infarction

75 mg orally once a day

Uses: Prevention of atherothrombotic events in patients with a history of recent myocardial infarction, recent stroke, or established peripheral arterial disease.

Usual Adult Dose for Peripheral Arterial Disease

75 mg orally once a day

Uses: Prevention of atherothrombotic events in patients with a history of recent myocardial infarction, recent stroke, or established peripheral arterial disease.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

No adjustment recommended

Precautions

US BOXED WARNING: DIMINISHED EFFECTIVENESS IN POOR METABOLIZERS:

• The effectiveness of this drug is dependent upon activation to an active metabolite via the CYP450 system, principally CYP450 2C19.
• CYP450 2C19 poor metabolizers treated with this drug at recommended doses exhibit a reduced effect on platelet activity compared to patients with normal CYP450 2C19 function.
• Tests are available to identify a patient's CYP450 2C19 genotype and can be used as an aid in determining therapeutic strategy.
• Consider alternative treatment or treatment strategies in patients identified as CYP450 2C19 poor metabolizers.

Dialysis

Data not available

Other Comments

Administration advice:

• This drug may be taken with or without food.
• Avoid concomitant use with omeprazole or esomeprazole. When a proton pump inhibitor is required, consider use of another acid reducing agent with minimal to no CYP450 2C19 inhibitory effect on the formation of this drug's active metabolite.
• Missed dose: A dose missed within 12 hours of its regularly scheduled time should be taken immediately; if more than 12 hours, the missed dose should be skipped and only the next regularly scheduled dose should be taken. Two doses of this drug should not be taken at the same time.

• Platelets exposed to the active metabolite of this drug are affected for the remainder of their lifespan (approximately 7 to 10 days) and recovery of normal platelet function occurs at a rate consistent with platelet turnover.

• Hematologic: Signs and symptoms of bleeding

• Inform patients of the increased risk of bleeding and bruising, and to report unanticipated, prolonged, or excessive bleeding, or blood in their stool/urine.
• Instruct patients to inform all healthcare providers, including dentists, that they are taking this drug, due to the increased risk of bleeding during surgery and dental procedures.
• Instruct patients to speak with their physician if they are taking any prescription or over the counter medications.
• Warn the patients of the symptoms of thrombotic thrombocytopenic purpura, and to seek medical attention immediately if they occur.

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