Heart Health : About Plavix
What Is Plavix (Clopidogrel Bisulfate)?
Plavix is the brand name form of the generic drug clopidogrel bisulfate, an anti-platelet medication that's used to prevent blood clots.
Blood clots can form in blood as a result of certain heart or blood vessel conditions.
For example, Plavix is often prescribed following a heart attack or stroke.
Plavix is also given to those who have unstable angina or peripheral artery disease.
Using Plavix in combination with aspirin may be more effective in preventing another heart attack, but this will increase your risk of bleeding.
Marketed by Bristol-Myers Squibb and Sanofi, Plavix was initially approved by the Food and Drug Administration (FDA) in 1997.
Since Plavix is designed to keep your platelets from coagulating and forming blood clots, it increases the likelihood that you might bleed, even if your injury is minor.
It's important that your doctor perform blood tests before you use this medicine to make sure that you don't have any genetic conditions that would make it dangerous for you to take Plavix.
If you have a stomach ulcer or a head injury that has caused bleeding in the brain, you should not use Plavix.
If you're planning to have any type of surgery or dental work, make sure your doctor is aware that you're using Plavix well in advance of the procedure.
Never use any medication, including Plavix, unless you are certain you're not allergic to it.
Talk to your doctor about any allergies you might have to similar medicines like prasugrel (Effient), ticagrelor (Brilinta) or ticlopidine (Ticlid), so that he/she can be sure Plavix is safe.
Let your doctor know about any serious conditions you might have, especially those involving bleeding or a blood-clotting disorder like TTP (thrombocytopenic purpura) or hemophilia.
You must also tell your doctor if you have a history of stroke, including mini-strokes known as TIAs, stomach ulcers, ulcerative colitis, and kidney disease.
Pregnancy and Plavix
Although Plavix is not known to be harmful to your fetus, it's still key that you let your doctor know if you're pregnant or might become pregnant while on Plavix.
There is insufficient data regarding breastfeeding, so doctors advise against breastfeeding if you're using Plavix.
Plavix in Cats
Plavix has been known to help decrease blood clots in cats.
Veterinarians prescribe it to help prevent feline aortic thromboembolism.
Talk to your veterinarian before giving your pet any drug, and follow your vet's directions carefully.
Plavix Side Effects
Common side effects of Plavix include:
- Head or joint pain
- Skin redness
- Taste problems
Stop taking Plavix and contact your doctor if you experience any of the following serious side effects:
- Bloody or tarry stools
- Blood in your urine
- Coughing up blood
- Vomiting that looks like coffee grounds
- Crushing heavy chest pain that spreads to arm, shoulder, or jaw
- Sudden numbness or weakness, especially on one side of your body
- Sudden headache
- Vision, speech, or balance problems
- Pale skin or yellowing of the skin or eyes (jaundice)
- Purple or red pinpoint spots under your skin
- Unusual bleeding in the mouth, vagina, or rectum
Get emergency help if you exhibit the following signs of an allergic reaction to Plavix:
- Difficulty breathing
- Swelling of the face, lips, tongue, or throat
Before beginning Plavix, it's important that you provide your doctor with a complete list of all the prescription and non-prescription drugs you're taking, including vitamins and herbal products, since they could interact with Plavix.
For example, combining Plavix with the following drugs could increase your risk of stomach and/or intestinal bleeding:
There are many other NSAIDs that can raise the risk of similar bleeding problems.
In 2009, the FDA warned against combining Plavix with acid-reducing products like esomeprazole (Nexium) or omeprazole (Prilosec) since they could substantially reduce the medication's effectiveness because they inhibit the enzyme CYP 2C19, which activates Plavix.
These products are designed to reduce acid in your stomach.
Other medications that inhibit this enzyme include:
In addition to avoiding medications or products that interact with Plavix, it's important to stay away from activities that could lead to bleeding or injury. You should also be careful about triggering bleeding when you shave or brush your teeth.
Try not to drink alcohol since it could also increase the risk of stomach or intestinal bleeding.
Most people take Plavix once a day.
It's a good idea to take this drug with food and lots of water in order to reduce the side effects.
Never stop taking Plavix without talking to your doctor.
Most people with unstable angina or heart attack begin with a 300-mg dose, followed by 75 mg once a day, taken together with 75 to 325 mg of aspirin.
If you have peripheral arterial disease or have had a recent stroke, your doctor will likely prescribe a dose of 75 mg daily.
Never take more Plavix than your doctor has prescribed.
If you're concerned that you or someone else might have overdosed, get to the emergency room right away or call a poison control center at (800) 222-1222.
Missed Dose of Plavix
If you forget to take your medication, take it as soon as you remember unless it's time for your next dose.
If it's time for your next dose, skip the missed dose and proceed with your regular dosing regimen.
Don't take extra pills to make up for a missed dose unless your doctor advises you to do so.
Q: I am taking 75 mg Plavix, 20 mg lisinopril, and 500 mg Keppra; can any of these cause weight gain and/or fatigue?
A: Both lisinopril and Keppra can cause you to have a tired feeling. Weight gain can be an issue with the lisinopril. If you are experiencing excessive weight gain or swelling, contact your health care provider. The tired feeling may lessen the longer you are on these medications, but it is still important to tell your provider.
Q: How long should you take Plavix? I had some stents put in over two years ago; should I still take Plavix?
Q: After having heart stents I have been taking Plavix for one year since the last stent was placed. Now I am getting two different opinions about length of taking the drug. One doctor says stop now and one doctor says stay on for life. What should I do?
A: Unfortunately, the medical community is still split on this decision. Plavix is so good at stopping blood clots from forming that many doctors advise patients to continue it for a year or more, as long as patients are not having bleeding problems or any other side effects. It also depends on whether your stent was coated with a medication or if it is a bare stent. People who receive stents that are coated with medication need longer courses of Plavix (clopidogrel), because it takes much longer for cells to cover their stents. The best thing to do is to have a discussion with your cardiologist in order to decide what your options are.
Q: After having a stent put in, how long should I take Plavix?
A: The length of treatment with Plavix (clopidogrel) following stent placement will depend on the type of stent that was placed. Generally, 12 to 15 months of treatment is the minimum. However, this can be extended, especially with drug-eluting stents. Your health care provider is best able to guide treatment decisions based on your specific circumstances. Do not stop or change the amount of medication you take without talking to your health care provider first. You may also find helpful information at: //www.everydayhealth.com/drugs/plavix
Q: Can Plavix cause stomach problems?
Q: If you have been taking Plavix for 4 years, does it still work the way it is supposed to? I've been on two different things from two different doctors and I have a stent in my right coronary artery.
A: Plavix is still relatively new and there is not enough information to determine it's long-term use. However, most doctors believe it is best to keep people on it right now. There was a recent study published that looked at coated stents and the use of Plavix. The older stents were metal and had a risk of scar tissue forming on them. Newer, coated stents were able to fight that better, but are believed to have a potential for catching blood cells that pass by and create a blood clot. Two studies were done in Korea over a year with coated stents using 2,700 patients. Some patients received Plavix and aspirin, and some received only the aspirin. Their study did not show a significant decrease in the risk of heart attacks or death from heart related problems. In a follow-up of 19.2 months, there was still not a significant change. However, this was considered to be a small group, over a short time, and more research must be done to determine the true facts. Most doctors feel that it is better to keep that possible added protection until further studies are done. As with all medications, keep consulting your doctor to see what drug regimen is best for you. For more information on heart conditions and medications, please visit our links at: //www.everydayhealth.com/heart-health/ Patti Brown, PharmD
Q: I take Plavix and have GERD. Zantac 300 mg is no longer helping my heartburn. What can I take with Plavix?
A: Treating heartburn and GERD can be tricky in patients taking Plavix (clopidogrel) because of drug interactions with the medications used to treat those symptoms. H2 Blockers, the class of drugs that includes Zantac (ranitidine), are okay to use. The exception is cimetidine which will interact with Plavix. The other main class of drugs used to treat GERD is the proton pump inhibitors (PPIs). The FDA has released a safety bulletin about using omeprazole, a PPI, with Plavix. This combination results in decreased effectiveness of Plavix, increasing the risk of heart attack or stroke. It is unclear if the other PPI drugs have the same effect and if it is to the same extent. Over-the-counter (OTC) antacids, such as Tums, may help somewhat. Always read and follow the complete directions and warnings on OTC medications and discuss their use with your healthcare provider before taking them. Contact your healthcare provider to discuss your treatment options. You may also find helpful information at //www.everydayhealth.com/drugs/plavixSarah Lewis, PharmD
Q: I had a TIA and my doctor put me on Plavix. Is there any alternative to that expensive drug?
A: A TIA (transient ischemic attack) is defined as a temporary block of blood flow to the brain caused by low blood flow, narrowing of the blood vessels, or a blood clot. The episode may last only a few minutes, but it may cause the patient to have slurred speech, changes in behavior, and memory or movement impairment. The cause of the TIA will determine which course of action to take. If your TIA was of unknown origin, then antiplatelet therapy is suggested with either aspirin, Plavix, or Aggrenox. Plavix is usually the first-line therapy. If your TIA was caused by a known blockage, then most likely the physician would have you take Coumadin, a blood thinner, to tackle the problem. Coumadin brings with it a load of complications, interactions, and the need for regular blood monitoring; it may not be something you need. The best thing to do is have a discussion with your physician to see there are any options that would work for you. Lori Poulin, PharmD
Q: I need a replacement for Plavix. Can you recommend anything?
Q: Is there a medication that can take the place of Plavix that would be cheaper?
A: Plavix (clopidogrel) is an antiplatelet medication, meaning that it helps keep platelets in the blood from sticking together and forming blood clots. Plavix does not come in generic form in the United States at this time. There are other medications that are antiplatelets, such as aspirin, dipyridamole, and ticlopidine. However, these medications are not interchangeable. You shouldn't make any changes in your medication without talking to your doctor first. For more information on Plavix, see //www.everydayhealth.com/drugs/plavix.
Q: My 102 year old father has been put on Plavix. What are the possible side effects?
A: Plavix (clopidogrel bisulfate) helps keep platelets in the blood from sticking together and forming clots, which are the direct cause of most heart attacks and strokes. It is recommended for people who have experienced a recent clot-related event, such as a heart attack or stroke, or who have been diagnosed with Peripheral Artery Disease (PAD); also known as poor circulation in the legs. In clinical trials, the most common side effects of Plavix were severe itching (pruritus), a severe rash characterized by the appearance of purplish spots or patches (purpura), diarrhea, and rash. For more specific information, consult with your doctor or pharmacist for guidance based on your specific condition and current medications. Shereen A. Gharbia, PharmD
Q: What would the interaction be between Plavix and Nexium?
A: Plavix (clopidogrel bisulfate) is an oral antiplatelet agent used to inhibit blood clots in coronary artery disease, peripheral vascular disease, and cerebrovascular disease. Generally speaking, drug interactions fall into three main categories: Drug-drug (i.e., prescription, over-the-counter, herbals, dietary supplements) interactions occur when two or more drugs react with each other. Drug-diet (food/drink) interactions result from drugs reacting with foods or drinks. Drug-disease interactions may occur when an existing medical condition makes certain drugs potentially harmful. Coadministration with proton pump inhibitors (PPIs), such as Nexium (esomeprazole) may reduce the cardioprotective effects of clopidogrel. Until further data is available, the use of proton pump inhibitors should preferably be avoided in patients treated with clopidogrel. PPIs should only be considered in high-risk patients such as those receiving dual antiplatelet therapy, those with a history of gastrointestinal bleeding or ulcers, and those receiving concomitant anticoagulant therapy, and then only after thorough assessment of risks versus benefits. If gastroprotection is necessary, H2-receptor antagonists or antacids should be prescribed whenever possible. For more specific information, consult with your doctor or pharmacist for guidance based on your specific condition and current medications. Shereen A. Gharbia, PharmD
Q: I've been taking Plavix for 20 years. It was prescribed after a heart attack. Should I stop?
A: According to drug information, Plavix is prescribed to reduce the rate of atherothrombotic events such as heart attacks. Therefore, patients that have had a heart attack in the past are often kept on this medication. I would not discontinue the medication without talking to your physician first. As always, talk with your healthcare provider regarding questions you have about your medications. Jen Marsico RPh
Q: I had a heart attack three weeks ago and was told that Plavix, that I had been on for 3 years, was not working for me. The cardiologist then doubled the dosage that I had been taking. Is there an alternative to Plavix?
A: Medications such as aspirin, Plavix (clopidogrel bisulfate), Ticlid (ticlopidine) and Aggrenox (aspirin/ dipyridamole) impair platelet function, so that platelets do not stick together as well. In laymen's terms this is called making "platelets less sticky"; in medical terms this is called "inhibiting platelet aggregation". The end result is that people do not clot as easily and this effect is mainly seen in the arteries. Talk to your doctor to find out if an alternative medication is appropriate. For more specific information, consult with your doctor or local pharmacist for guidance based on your specific condition and current medications. Shereen A. Gharbia, PharmD
Q: If I am taking Plavix and low-dose aspirin, what other pain reliever can I take for headache or muscle pain that is safe?
Q: My cardiologist said I shouldn't take omeprazole with Plavix. He switched me to Pepcid, which doesn't take care of my upset stomach. Any thoughts or suggestions?
A: Unfortunately, your doctor is right. omeprazole should not be used by a patient on Plavix. Nor can any of the other drugs that are in the same subcategory as omeprazole be used. If you are not getting adequate relief from Pepcid, perhaps you might want to discuss with your health care provider the possibility of changing to another product in the same class as Pepcid, such as Axid or Zantac, to see if they give you more relief. It is always a good idea to check with one
Q: I was placed on Plavix following a headache; however, it was not a stroke. I have been using it for a year. I am 67-year-old female. Will I have to always take it?
A: Your question regards Plavix (clopidogrel) //www.everydayhealth.com/drugs/plavix According to Lexi-Comp, Plavix is used to help prevent the clotting of platelets in your blood. It is usually used in patients that have a history of heart attack or stroke or in patients that have certain disorders of their blood vessels. I would speak to your prescribing physician regarding why you were put on the medication. Patients that are being treated for the above uses, will likely be on the medication for the long duration. Your physician could provide information about your treatment duration. Jen Marsico, RPh
Q: What are the pros and cons of taking Plavix and Prilosec together?
A: In 2009, the Food and Drug Administration (FDA) issued a Public Health Advisory concerning the combined use of Plavix (clopidogrel) and Prilosec (omeprazole). Their review of available data indicate that the effectiveness of Plavix will be reduced by approximately half when combined with Prilosec. Patients at risk for heart attacks or strokes who use Plavix will not get the full anti-blood clotting effect when taken with Prilosec. Separating the doses of these two medications will not prevent this drug interaction. Other proton pump inhibitors (PPIs), the class of drugs that includes Prilosec, may or may not have the same effect. Other stomach acid treatment options for patients on Plavix include antacids, like Maalox or Mylanta, and most acid reducers, including Zantac (ranitidine), Pepcid (famotidine), and Axid (nizatidine). However, Tagamet (cimetidine) should not be used. FDA recognizes that patients on Plavix frequently need medications to control stomach acid, like Prilosec. Therefore, they provide the following recommendations for patients on Plavix: Patients using clopidogrel should consult with their health care provider if they are currently taking or considering taking omeprazole, including Prilosec OTC. Both clopidogrel and omeprazole can provide significant benefits to patients, and patients should always consult with their health care professional before starting or stopping any medication. It is very important that patients talk with their health care professional about any over-the-counter (OTC) drugs they are taking before starting or while using clopidogrel Consult your health care provider for recommendations based on your specific circumstances. Sarah McKenney Lewis, PharmD, PharmD For more health information, visit everydayhealth.com and sign up for free newsletters. This site is provided for informational and educational purposes only. You may not rely on this site for professional medical advice, diagnosis or treatment, pharmacist advice or any professional service requiring licensure, registration or certification in any state. Follow the instructions of your health care provider and read carefully all product packaging associated with any medication that is provided to you. Medication information offered on this site is for informational purposes only and is neither independently verified nor endorsed by Everyday Health, Inc. We cannot offer any assurances that any product is safe, effective or appropriate for you. If you are in need of medical attention, contact your physician or other health care provider or dial 911 if you believe that you are experiencing a medical emergency. -
Q: Is Plavix supposed to smell like vinegar?
A: Plavix (clopidogrel) is used to reduce the risk of stroke or heart attack in patients who have already had a heart attack or stroke or in patients who have other heart and circulatory problems. There is no information about Plavix smelling like vinegar. For other drugs, like aspirin, a strong vinegar-like smell can indicate that the drug is breaking down and should not be used. Please contact your local pharmacist to examine the medication and determine the appropriate course of action. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Michelle McDermott, PharmD
Q: Is the generic Plavix as effective as the original Plavix? How long should one be on Plavix?
Q: My pharmacy wanted to give me a new generic medicine - Grepid, clopidogrel, instead of Plavix, which I have bought until now. This Grepid was so much cheaper I was told, but I don't know if I dare. I have had two apoplexies and two TIAs since 1992.
A: Unfortunately we
Q: Should you continue to take Plavix after one year?
A: Only your physician can determine how long you need to be on your prescribed medication based on the reason it was prescribed and your underlying health status. Plavix (clopidogrel) can be taken with or without food. Because clopidogrel keeps your blood from coagulating (clotting) to prevent unwanted blood clots, it can also make it easier for you to bleed, even from a minor injury. Contact your doctor or seek emergency medical attention if you have bleeding that will not stop. If you need to have any type of surgery or dental work, tell the surgeon or dentist ahead of time that you are using clopidogrel. You may need to stop using the medicine for at least five days before having surgery, to prevent excessive bleeding. To be sure this medication is not causing harmful effects, your blood will need to be tested on a regular basis. Do not miss any scheduled visits to your doctor. Store clopidogrel at room temperature away from moisture and heat. Lowell Sterler, RPh
Q: I've been taking Plavix 75 mg for a year. I just went to my cardiologist and he told me I no longer need it because it's no longer effective. Is this accurate information?
A: Plavix (clopidogrel) inhibits the platelets in the blood from clotting and is used to prevent blood clots that can occur after a heart attack, stroke and in patients with certain heart and blood vessel disorders. According to the prescribing information available for Plavix (clopidogrel), lapses in treatment should be avoided and if Plavix must be temporarily discontinued, it should be restarted as soon as possible. Additionally, the prescribing information indicates that premature discontinuation of Plavix (clopidogrel) may increase the risk for cardiovascular events and there is no mention of Plavix losing its efficacy after one year. It is important to take Plavix (clopidogrel) exactly as directed by your health care provider and do not take it longer than recommended. The most commonly reported side effect associated with Plavix (clopidogrel) treatment was bleeding. If you experience any signs and symptoms of bleeding, including nosebleeds or other bleeding that will not stop, coughing up blood or vomit that looks like coffee grounds or black, bloody or tarry stools, it is important to contact your healthcare provider immediately. For more specific information based on your specific condition and current medications, consult with your health care provider, particularly before taking any action. Beth Isaac, PharmD
Q: I had a heart attack in May of 2009 and a single stent was put in place. I have been taking 81 mg of aspirin and 75 mg of Plavix since then. Still advisable?
A: Aspirin is in a medication class called salicylates. Aspirin, in prescription form, is used to treat symptoms of osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, and other conditions associated with pain and swelling. Over-the-counter aspirin is used to lessen fever and treat pain from a variety of conditions. In addition, over-the-counter aspirin is used to prevent heart attack in people who have had a heart attack or who experience angina; and it is used in the treatment of a heart attack. Over-the-counter aspirin is also used to prevent certain types of strokes. Aspirin works by blocking the production of certain naturally-occurring substances that lead to fever, pain, swelling, and blood clots. Aspirin can cause serious side effects including bleeding and gastric ulcers. Plavix (clopidogrel) is in a drug class called antiplatelet drugs. Plavix is used to prevent heart attack and stroke in people who are at risk for these events. Plavix works by preventing blood clots that can cause heart attack or stroke. There is a recent addition to the warnings with Plavix. In order for Plavix to work in the body, the medication needs to be converted in the body to the active form. Some people may not be able to convert the medication as well as others. It is advised to speak with your health care provider in regards to this warning. Some of the risks of Plavix therapy may include abdominal pain, vomiting, constipation, and increased risk of bleeding. Aspirin therapy may have benefits, but it is not without risks. Some of the benefits of aspirin may include: prevention of first and second heart attack; reduction in heart disease risk; and prevention of stroke. Some of the risks involved in aspirin therapy include: hemorrhagic stroke, gastrointestinal bleeding, allergic reaction, and tinnitus (ringing in the ears). Both the benefits and risks of aspirin therapy are patient specific and may depend on certain factors including heart disease risks, age, sex, and other medical conditions. Only your health care provider can recommend which treatment is appropriate for you. Please consult with your health care provider in regards to your treatment with aspirin and Plavix. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Kristen Dore, PharmD
Q: I had a stent put in my artery on 2007. I take everyday one tablet of Plavix 75 mg. Fow how long must I take the Plavix?
A: The recommended daily dose of Plavix (clopidogrel) is 75 mg once daily, indefinitely or until your physician says otherwise. Did you know that a generic does exist? For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action.
Q: Should I be taking aspirin and Plavix together? I have not had a heart attack but have had a number of stents put in.
A: When a patient has a stent placed in the body, which is a wire mesh placed in the blood vessel wall, it takes time for the lining of the blood vessel to grow over the top of that wire mesh. During this process, it is possible for blood clots to form. It is common practice for physicians to prescribe aspirin and Plavix together. They work together to help prevent the blood clots from forming around the stent. Usually these two medications will be prescribed for at least one month, the time it takes for the lining of the blood vessel to grow over the stent. You will have to take one or the other of these medications for a longer period of time to continue to prevent blood clots from forming. Your physician will be better enabled to answer the question of how long you will take the medications. It is very important that you follow the medication regimen exactly as you are told. Do not stop taking any of the prescribed medications unless you are instructed to do so only by the physician who implanted your stent. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Lori Poulin, PharmD
Q: My husband was put on Plavix 12 weeks ago after his first heart attack. I have been reading that it causes ulcers. Is it risky because of that ?
A: Plavix (clopidogrel) (//www.everydayhealth.com/drugs/plavix) is a platelet aggregation inhibitor that works by slowly or stopping platelets from sticking to blood vessels. Plavix reduces the risk of heart attacks and strokes for people who are already at risk and also helps with circulation problems caused by narrowing of the arteries. (//www.everydayhealth.com/stroke/guide/) (//www.everydayhealth.com/heart-health/). Common side effects of Plavix include bleeding and bruising. A search of prescribing information did not specifically list ulcers as an adverse effect of Plavix. This is not a complete list of side effects associated with Plavix. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. When your doctor prescribes a new medication, be sure to discuss all your prescription medications and over-the-counter drugs, including dietary supplements, vitamins, botanicals, minerals and herbals, as well as foods you eat. Always keep a current list of the drugs and supplements you take and review it with your healthcare providers and your pharmacist. If possible, use one pharmacy for all your prescriptions and over-the-counter products. This allows your pharmacist to keep a complete record of all your prescription drugs and advise you about drug interactions and side effects. Tell your health-care provider about any negative side effects from prescription drugs. You can also report them to the U.S Food and Drug Administration by visiting //www.fda.gov/Safety/MedWatch/default.htm or by calling 1-800-FDA-1088. Kimberly Hotz, PharmD
Q: Can Plavix make you gain weight or keep you from losing it? I have been on it for a year.
A: Plavix (clopidogrel) works to reduce the blood from clotting by keeping platelets from sticking together. Plavix is used to prevent blood clots after a recent heart attack or stroke, and in people with certain disorders of the heart or blood vessels. The most common side effects of Plavix are bleeding and itching. A search of the prescribing information for Plavix did not specifically list weight gain as a side effect. Drugs can cause weight gain in several different ways. Some can increase appetite or make you crave certain types of foods like those high in carbohydrates or fat. Other medications may slow down metabolism or cause fluid retention. However, the effect of prescription drugs on body weight is complex. Some drugs have no effect on weight, while others cause weight gain or weight loss. Also, the same medications can cause weight gain in certain individuals and weight loss in others. There are also drugs that initially cause weight loss and then lead to weight gain with long-term use. Most prescription medications associated with changes in body weight affect the central nervous system. These include antidepressants like monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants, and selective serotonin reuptake inhibitors (SSRIs). Mood stabilizers (lithium, valproic acid), antipsychotics, and anticonvulsants have also been linked with weight gain. Other drugs that have been reported to cause weight gain include diabetes medications (insulin, sulfonylureas, and thiazolidinediones), antihypertensive drugs, certain hormonal contraceptives, corticosteroids, antihistamines, some chemotherapy regimens, and antiretroviral protease inhibitors. If you think a drug you are taking is causing weight gain, tell your health care provider. Do not stop any medication or change the dose without first talking to your provider. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Michelle McDermott, RPh
Q: Can Plavix cause blood vessels to break in the eye?
A: Plavix (clopidogrel) is a medication that is used to prevent blood clots. It keeps the platelets in your blood from clotting to prevent unwanted blood clots in patients with heart or blood vessel conditions. The prescribing information for Plavix does list eye disorders such as conjunctival (white part of the eye), ocular, and retinal bleeding as side effects of this medication. If you experience any type of bleeding in the eye, you should consult with your physician to be sure damage is not being done to your eyesight. Lori Poulin, PharmD
Q: I've started taking Plavix. Is it okay to eat the green vitamin K foods, and do I need to take something like Tagamet to protect my stomach?
A: Plavix works by preventing the platelets in the blood from clotting together to prevent blood clots that occur with various heart and blood vessel conditions. Plavix is used to prevent blood clots in patients after a heart attack or stroke or in those patients with disorders of the heart or blood vessels. Unlike Coumadin (warfarin), Plavix does not interact with vitamin K containing foods according to the prescribing information. You may want to contact your health care provider to address your question regarding stomach protection during treatment with Plavix. It is important to discuss the use of all medications, prescription and over the counter, with your doctor before starting any new treatment. You can also find helpful information on Plavix at //www.everydayhealth.com/drugs/plavix. Beth Isaac, PharmD
Q: I am taking Plavix. Can I safely eat grapefruit, or will it have an effect on the Plavix?
Q: My 90-year-old dad has been on Plavix for a long time. As a result, his skin is very thin and bruises easily. Could a triglyceride-based fish oil and vitamin E do the same thing?
A: Generally, dermatologic side effects from omega-3 fish oils and vitamin E consist of itching, rashes, or dermatitis. Skin naturally thins with age and may contribute to bruising. Omega-3 fish oil may increase the risk of bleeding, so any unusual or easy bruising should be reported to your health care provider right away. Other signs of bleeding include nosebleeds, bleeding gums, cuts that don't heal easily, and dark urine or stools. You may also find helpful information at //www.everydayhealth.com/drugs/plavix. Sarah Lewis, PharmD
Q: I had a small stroke and am taking Plavix now, but it's giving me stomach problems. Is there a better medication for me?
A: Plavix (clopidogrel) is an antiplatelet medication that keeps the blood from clotting, to prevent heart attack or stroke. Plavix may be harsh on the stomach, as stomach pain is one of the more common side effects seen with this medication. There are alternatives to Plavix, but your doctor must be the one to determine if any of them are acceptable treatments for your health. Speak with your doctor to about the side effects you're experiencing. Some other treatments may include aspirin, Aggrenox (aspirin/dipyridamole), Ticlid (ticlopidine), Pletal (cilostazol), and Effient (prasugrel). For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Megan Uehara, PharmD
Q: I have been told that Prilosec will interfere with Plavix use. Is this true?
A: Recent research has shown that there is a possible interaction between Plavix and the class of medications referred to as proton pump inhibitors (PPIs), of which Prilosec (omeprazole) is a member. Plavix needs help being broken down in the body before it becomes active. Apparently the mechanism that breaks down Plavix is affected by the Prilosec, thereby possibly making Plavix less effective. It appears that other medications for acid reduction such as Zantac (ranitidine), Pepcid (famotidine) etc. probably do not affect this process, although Tagamet (cimetidine) may be an exception. It may be helpful to speak with your physician about this interaction and see if a change in medication would be beneficial for you.
Q: What pain killers are safe to take with Plavix?
A: This is a very good question as Plavix can interact with many painkillers. Tylenol (generic name acetaminophen) poses the least risk with Plavix and is the drug of choice. It is recommended to stay away from NSAIDS (like Advil, Motrin, Aleve, and aspirin) since these can tend to increase the risk of bleeding. You can always try asking your doctor what drug they would prefer for you to take for pain purposes. Megan Uehara, PharmD
Q: I have been taking Plavix for 2 years because of an infarct and 5 stents in 2008. Should I continue or is it enough?
A: Plavix (clopidogrel) is an anti-platelet agent that keeps the platelets from sticking together to form a blood clot. Plavix is used to prevent blood clots after a recent heart attack or stroke and in people who have certain problems with the heart or blood vessels. According to the prescribing information, Plavix has been shown to reduce the rate of death from any cause and the rate of any of the following: death, another heart attack, and stroke. The duration of therapy is best determined by your health care provider based on your current health status and current medications. Do not stop or change the dose of your medication without talking to your healthcare provider first. Michelle McDermott, PharmD
Q: Can I take ranitidine with Plavix?
A: Plavix (clopidogrel) keeps the platelets in the blood from coagulating or clotting to prevent unwanted blood clots. Plavix is used to prevent blood clots after a recent heart attack or stroke, and in people with certain disorders of the heart or blood vessels. Ranitidine (Zantac) belongs to a class of drugs called histamine-2 (H2) blockers that works by reducing the amount of acid the stomach produces. While some drugs in this H2 blocker class, such as cimetidine (Tagamet), can interfere with the clotting action of Plavix, rantidine does not. Ranitidine, famotidine (Pepcid), and antacids are not expected to interfere with the anti-clotting activity of Plavix. However, another class of acid reducers, the proton pump inhibitors (PPIs), should be avoided with Plavix. An example of a PPI is omeprazole (Prilosec). It's important to be aware of these interactions since many of these acid-reducing medications are available over-the-counter. Always read and follow the complete directions and warnings on over-the-counter medicines and discuss their use with your doctor before taking them. For more specific information, consult with your doctor or local pharmacist for guidance based on your health status and current medications, particularly before taking any action. Sarah Lewis, PharmD
Q: Can Plavix or Aspirin affect healing associated with a tattoo?
A: Plavix (clopidogrel), which keeps the platelets in your blood from coagulating (clotting) to prevent unwanted blood clots that can occur with certain heart or blood vessel conditions, is used to prevent blood clots after a recent heart attack or stroke, and in people with certain disorders of the heart or blood vessels. The most common side effects with Plavix are pruritus (intense itching sensation), purpura (bleeding under the skin), diarrhea, and rash. Aspirin, one of a group of drugs called salicylates, works by reducing substances in the body that cause pain, fever, and inflammation. Aspirin is used to treat mild to moderate pain, and also to reduce fever or inflammation. Aspirin is sometimes used to treat or prevent heart attacks, strokes, and chest pain (angina). Aspirin should be used for cardiovascular conditions only under the supervision of a doctor. The most common side effects with aspirin are nausea, dyspepsia (upset stomach), tinnitus (ringing or roaring in the ears) with large doses, and dizziness with large doses. The combination of Plavix and aspirin can increase the risk of further bleeding. This is not a complete list of the side effects associated with Plavix or aspirin. Gregory Latham, RPh
Q: Does Plavix cause dizziness?
A: According to the prescribing information, dizziness was not a reported side effects associated with Plavix (clopidogrel) treatment. Plavix (clopidogrel) inhibits the platelets in the blood from clotting and is used to prevent blood clots that can occur after a heart attack, stroke and in patients with certain heart and blood vessel disorders. According to the prescribing information, the most commonly reported side effect associated with Plavix treatment was bleeding. If you experience any signs and symptoms of bleeding, including nosebleeds or other bleeding that will not stop, coughing up blood or vomit that looks like coffee grounds or black, bloody or tarry stools, it is important to contact your healthcare provider immediately. Plavix should be taken with a full glass of water and can be taken without regard to food. If you need dental work or surgery, it is extremely important to inform your doctor that you take Plavix. You may need to stop taking Plavix for at least 5 days prior to surgery or a procedure to avoid bleeding excessively. This should only be done under the supervision of your doctor. You should begin taking Plavix as soon as possible and exactly as directed by your doctor. Beth Isaac, PharmD
Q: Does cranberry juice interfere with Plavix?
A: Plavix (clopidogrel) hinders the platelets in the blood from coagulating (clotting) to prevent unwanted blood clots that can occur with certain heart or blood vessel conditions. Plavix is used to prevent blood clots after a recent heart attack or stroke and in people with certain disorders of the heart or blood vessels. As a result of the action of this drug, Plavix can make it easier for bleeding to occur, even from a minor injury. There are no documented medical reports or research studies that have concluded that cranberry juice has any effect on Plavix. There have been some reports that cranberry juice should not be taken with Coumadin (warfarin), because it may lengthen the clotting time even further. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Gregory Latham, RPh
Q: I have been diagnosed with hardening of the arteries and I am taking Plavix. Is there anything I can do to reverse my situation?
A: Plavix (clopidogrel), an oral antiplatelet agent, is used to inhibit blood clots in patients with coronary artery disease, peripheral vascular disease, and cerebrovascular disease. In clinical trials, the most common side effects of Plavix were severe itching (pruritus), a severe rash characterized by the appearance of purplish spots or patches (purpura), diarrhea, and rash. According to the literature, patients who lowered LDL ("bad") cholesterol with statin drugs to about 60 mg/dL, on average, regressed plaques (reduced plaque in the coronary arteries). Reducing LDL cholesterol to low levels is important and is the cornerstone of therapy. Raising HDL ("good") cholesterol appears to be equally important. In addition, regular exercise and controlling blood pressure has been shown to dramatically benefit heart patients. In summary, if you keep your LDL down, your HDL up, avoid smoking, exercise regularly, and control your blood pressure, you have a good chance at slowing or reversing the buildup of plaque in your arteries. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Shereen A. Gharbia, PharmD
Q: Can Plavix cause taste disturbances?
A: Plavix (clopidogrel) prevents platelets from coagulating or forming blood clots. Normally, the body needs platelets to form clots. Plavix is used to prevent blood clots in people with recent heart attacks, strokes, and arterial and vascular diseases. Common side effects of Plavix include abdominal pain, constipation, diarrhea, indigestion, itching, headache, joint pain, back pain, and bruising. According to the prescribing information for Plavix, taste changes or taste disorders has been reported by patients taking the drug in post-marketing experience. Post-marketing experience is after the drug has been approved by the U.S. Food and Drug Administration (FDA). In post-marketing experience, patient voluntarily report side effects. Because it is voluntary, not everyone decides to report it if they have the side-effect. So, it is hard to know how often the side effect occurs. It is also hard to know if it is caused by the drug or by some other reason. This is different than side effects reported during clinical trials before the drug is approved by the FDA. In clinical trials, researchers have tight control over how side effects are reported and can determine whether they are likely related to the drug or not. So, taste changes may or may not be cause by Plavix, but they have been reported. Sarah Lewis, PharmD
Q: Is it recommended to take Plavix after a heart attack and receiving a stent?
A: Stents are used when an artery in the heart is narrowing due to plaque buildup. Stents help to keep the arteries open to reduce the risk of heart attacks. After a stent is put in place, blood thinning medications are used to prevent a blood clot from forming in the stent and blocking the artery. According to the American Heart Association, Plavix and aspirin are used after a stent is placed, as long as there are no contraindications to their use. Aspirin is used indefinitely. Plavix is used for one to twelve months, or even longer, depending on the type of stent that is put in place. Please consult with your health care provider in regards to the length of time you should be on Plavix. Plavix (clopidogrel) is in a class of medications known as platelet inhibitors. Plavix is used to prevent heart attacks and strokes. Plavix works by stopping the blood clots from forming that may lead to a heart attack or stroke. Aspirin is in a medication class called salicylates. Aspirin, in prescription form, is used to treat symptoms of osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, and other conditions associated with pain and swelling. Over-the-counter aspirin is used to lessen fever and treat pain from a variety of conditions. In addition, over-the-counter aspirin is used to prevent heart attack in people who have had a heart attack or who experience angina; and it is used in the treatment of a heart attack. Over-the-counter aspirin is also used to prevent certain types of strokes. Kristen Dore, PharmD
Q: Is Nattokinase a safe alternative to Plavix? I heard you shouldn't take Plavix after age 70. I'm concerned as now I've turned 70. I've had 10 stents and a heart attack.
A: Plavix (clopidogrel) works to reduce the formation of blood clots by preventing the platelets from sticking together. Plavix is used in patients who have had a recent heart attack or stroke, and in people with certain heart or blood vessel problems. In the clinical studies that were done to test the efficacy and safety of Plavix, about 25 percent of patients were 70 years and older and 15 percent were 75 years and older. The risk of bleeding as a side effect increased with increasing age and was 6 percent in the Plavix group who were older than 75 years. There are no required dosage adjustments for Plavix as people age. Nattokinase is a dietary supplement that is produced from soybeans. Nattokinase has been used to break up clots that may be clogging an artery. However, there is very limited information on this use in humans. Most clinical studies have been done with only small numbers of patients and have only shown decreases in substances in the blood that the body uses to form clots. There is no information that shows Nattokinase reduces the risk of adverse cardiovascular events, such as heart attack or stroke. It is important to understand that dietary supplements, like Nattokinase, are not required to be tested the same way prescription drug products are tested, so information about effectiveness, safety, and dosing is limited. The U.S. Food and Drug Administration (FDA) does not approve these types of products for use in humans to prevent, treat, or cure any specific disease. If you have concerns about your medication, talk to your doctor. Do not stop or change your medication unless your doctor directs you to do so. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Michelle McDermott, PharmD
Q: My doctor has taken me off of Plavix after 5 years on it. I take low-dose aspirin 81 mg daily. I have done great with the drug. What can I take in place of Plavix to help keep my cholesterol down at 110?
A: Aspirin is in a group of drugs called salicylates. Aspirin works by reducing substances in the body that cause pain, fever, and inflammation. Aspirin is used to treat mild to moderate pain, and also to reduce fever or inflammation. Aspirin can sometimes be used to treat or prevent heart attacks, strokes, and angina. Your doctor may use aspirin for other purposes also. Plavix (clopidogrel) is a platelet aggregation inhibitor that works by slowling or stopping platelets from sticking to blood vessels. Plavix reduces the risk of heart attacks and strokes for people who are already at risk and also helps with circulation problems caused by narrowing of the arteries. Plavix does not work to control cholesterol. Consult with the healthcare provider for treatment on lowering cholesterol. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action.
Video: Ask the Jefferson Experts - Is it OK to Stop Plavix after a Stent Placement?
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