Side effects of plavix

Ask the doctor: Is it okay to take aspirin, Plavix, and warfarin?

Ask the doctor

Is it okay to take aspirin, Plavix, and warfarin?

Published: March, 2008

Q. I am 85 years old. A little over a year ago, I had an angioplasty with placement of a stent. Since then I have been on low-dose aspirin and Plavix without any problems. I just learned I have atrial fibrillation, and my doctor wants me to take Coumadin. That means I would be taking three drugs that prevent blood clots. Is this dangerous? Should I stop taking aspirin and Plavix? Or could I just take aspirin and Plavix without the Coumadin to prevent problems from atrial fibrillation?

A. You are right to be concerned about combining these three drugs, as each of them increases your risk of bleeding problems. However, they act in different ways, and just because you take one doesn’t mean you shouldn’t take the others. Aspirin and clopidogrel (Plavix) help stop platelets from clumping together inside your arteries. This reduces the chances that an artery-closing clot will develop on or near your stent. Warfarin (Coumadin) blocks vitamin K, a key player in the blood clotting cascade. By preventing the kind of blood clots that can form in the upper chambers of the heart when they beat too rapidly, warfarin reduces the risk of stroke due to atrial fibrillation.

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MONDAY, Nov. 17, 2014 (HealthDay News) — Heart attack and stroke patients can safely take aspirin combined with a blood-thinning medication, new research confirms.

The blood-thinning combination won’t increase a patient’s risk of early death, according to a new study presented Sunday at the annual meeting of the American Heart Association in Chicago. The report was also published online Nov. 16 in The Lancet.

Analysis of data from more than a dozen clinical trials revealed no increase in death rate if heart patients took both drugs together for long periods of time, said study co-author Dr. Laura Mauri, an associate professor of cardiovascular medicine at Harvard Medical School in Boston.

“Patients should not be afraid of taking these medications,” Mauri said. “In fact, it’s important they continue to take them as directed, because they can be life-saving.”

The U.S. Food and Drug Administration issued a drug safety communication based on the results of the analysis that said that the benefits of the drugs “continue to outweigh their potential risks,” which include excessive bleeding.

“Patients should not stop taking these drugs because doing so may result in an increased risk of heart attacks, blood clots, strokes and other major cardiovascular problems,” the FDA statement said. “Health care professionals should not change the way they prescribe these drugs at this time.”

Following a stroke or heart attack, patients often are prescribed medications that reduce blood clots by interfering with clotting cells called platelets. These antiplatelet drugs reduce the risk of a follow-up stroke or heart attack.

Aspirin is a mainstay blood thinner, and doctors often combine aspirin with newer anti-clotting drugs like clopidogrel (Plavix) or prasugrel (Effient), the researchers said in background material.

But a pair of recent clinical trials revealed an unexpectedly high death rate associated with the combination, raising concerns that using the drugs together could be harming patients in some unknown way, Mauri said.

For example, the Dual Antiplatelet Therapy (DAPT) trial — another study presented at the AHA meeting in Chicago — showed significant benefits for extending the combination therapy longer than the clinical standard of 12 months in heart attack patients who’ve received a stent to reopen a blocked artery.

Plavix

SIDE EFFECTS

The following serious adverse reactions are discussed below and elsewhere in the labeling:

  • Bleeding
  • Thrombotic thrombocytopenic purpura

Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions and durations of follow-up, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

Plavix has been evaluated for safety in more than 54,000 patients, including over 21,000 patients treated for one year or more. The clinically important adverse reactions observed in trials comparing Plavix plus aspirin to placebo plus aspirin and trials comparing Plavix alone to aspirin alone are discussed below.

Bleeding

CURE

In CURE, Plavix use with aspirin was associated with an increase in major bleeding (primarily gastrointestinal and at puncture sites) compared to placebo with aspirin (see Table 1). The incidence of intracranial hemorrhage (0.1%) and fatal bleeding (0.2%) were the same in both groups. Other bleeding events that were reported more frequently in the clopidogrel group were epistaxis, hematuria, and bruise.

The overall incidence of bleeding is described in Table 1.

Table 1: CURE Incidence of Bleeding Complications (% patients)

Event Plavix
(+ aspirin)
(n=6259)
Placebo
(+ aspirin)
(n=6303)
Major bleeding* 3.7 2.7
Life-threatening bleeding 2.2 1.8
Fatal 0.2 0.2
5 g/dL hemoglobin drop 0.9 0.9
Requiring surgical intervention 0.7 0.7
Hemorrhagic strokes 0.1 0.1
Requiring inotropes 0.5 0.5
Requiring transfusion (≥4 units) 1.2 1.0
Other major bleeding 1.6 1.0
Significantly disabling 0.4 0.3
Intraocular bleeding with significant loss of vision 0.05 0.03
Requiring 2-3 units of blood 1.3 0.9
Minor bleeding† 5.1 2.4
* Life-threatening and other major bleeding.
† Led to interruption of study medication.

COMMIT

In COMMIT, similar rates of major bleeding were observed in the Plavix and placebo groups, both of which also received aspirin (see Table 2).

Table 2: Incidence of Bleeding Events in COMMIT (% patients)

CAPRIE (Plavix Vs Aspirin)

In CAPRIE, gastrointestinal hemorrhage occurred at a rate of 2.0% in those taking Plavix versus 2.7% in those taking aspirin; bleeding requiring hospitalization occurred in 0.7% and 1.1%, respectively. The incidence of intracranial hemorrhage was 0.4% for Plavix compared to 0.5% for aspirin.

Other bleeding events that were reported more frequently in the Plavix group were epistaxis and hematoma.

Other Adverse Events

In CURE and CHARISMA, which compared Plavix plus aspirin to aspirin alone, there was no difference in the rate of adverse events (other than bleeding) between Plavix and placebo.

In CAPRIE, which compared Plavix to aspirin, pruritus was more frequently reported in those taking Plavix. No other difference in the rate of adverse events (other than bleeding) was reported.

Postmarketing Experience

The following adverse reactions have been identified during postapproval use of Plavix. Because these reactions are reported voluntarily from a population of an unknown size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

Hemorrhages, including those with fatal outcome, have been reported in patients treated with Plavix.

  • Blood and lymphatic system disorders: Agranulocytosis, aplastic anemia/pancytopenia, thrombotic thrombocytopenic purpura (TTP), acquired hemophilia A
  • Gastrointestinal disorders: Colitis (including ulcerative or lymphocytic colitis), pancreatitis, stomatitis, gastric/duodenal ulcer, diarrhea
  • General disorders and administration site condition: Fever
  • Hepatobiliary disorders: Acute liver failure, hepatitis (noninfectious), abnormal liver function test
  • Immune system disorders: Hypersensitivity reactions, anaphylactoid reactions, serum sickness, insulin autoimmune syndrome, which can lead to severe hypoglycemia.
  • Musculoskeletal, connective tissue and bone disorders: Myalgia, arthralgia, arthritis
  • Nervous system disorders: Taste disorders, headache, ageusia
  • Psychiatric disorders: Confusion, hallucinations
  • Respiratory, thoracic and mediastinal disorders: Bronchospasm, interstitial pneumonitis, eosinophilic pneumonia
  • Renal and urinary disorders: Increased creatinine levels
  • Skin and subcutaneous tissue disorders: Maculopapular, erythematous or exfoliative rash, urticaria, bullous dermatitis, eczema, toxic epidermal necrolysis, Stevens-Johnson syndrome, acute generalized exanthematous pustulosis (AGEP), angioedema, drug-induced hypersensitivity syndrome, drug rash with eosinophilia and systemic symptoms (DRESS), erythema multiforme, lichen planus, generalized pruritus
  • Vascular disorders: Vasculitis, hypotension

Read the entire FDA prescribing information for Plavix (Clopidogrel Bisulfate)

Clopidogrel 75mg film-coated Tablets

UK Edition. .

Clopidogrel (as hydrochloride)

Read all of this leaflet carefully before you start to take this medicine.

  • Keep this leaflet. You may need to read it again while you are receiving your treatment.
  • If you have any further questions, ask your doctor or pharmacist.
  • This medicine has been prescribed for you. Do not pass it on to others. It may harm them, even if their symptoms are the same as yours.
  • If any of the side effects get serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.

In this leaflet:

  1. What Clopidogrel Tablets are and what they are used for
  2. Before you take Clopidogrel Tablets
  3. How to take Clopidogrel Tablets
  4. Possible side effects
  5. How to store Clopidogrel Tablets
  6. Further information

1. WHAT CLOPIDOGREL TABLETS ARE AND WHAT THEY ARE USED FOR

Clopidogrel Tablets belong to a group of medicines called antiplatelet medicinal products. Platelets are very small structures in the blood, which clump together during blood clotting. By preventing this clumping, antiplatelet medicinal products reduce the chances of blood clots forming (a process called thrombosis).

Clopidogrel Tablets are taken to prevent blood clots (thrombi) forming in hardened blood vessels (arteries), a process known as atherothrombosis, which can lead to atherothrombotic events (such as stroke, heart attack or death).

You have been prescribed Clopidogrel Tablets to help prevent blood clots and reduce the risk of these severe events because:

  • You have a condition of hardening of the arteries (also known as atherosclerosis), and
  • You have previously experienced a heart attack, stroke or have a condition known as peripheral arterial disease.

2. BEFORE YOU TAKE CLOPIDOGREL TABLETS

Do not take Clopidogrel Tablets:

  • If you are allergic (hypersensitive) to clopidogrel or any of the other ingredients in Clopidogrel Tablets
  • If you have a medical condition that is currently causing bleeding such as a stomach ulcer or bleeding within the brain
  • If you suffer from severe liver disease

If you think any of these apply to you, or if you are in any doubt at all, consult your doctor before taking Clopidogrel Tablets.

Take special care with Clopidogrel Tablets:

If any of the situations mentioned below apply to you, you should tell your doctor before taking Clopidogrel Tablets:

  • if you have a risk of bleeding such as:
    • a medical condition that puts you at risk of internal bleeding (such as a stomach ulcer)
    • a blood disorder that makes you prone to internal bleeding (bleeding inside any tissues, organs or joints of your body)
    • a recent serious injury
    • a recent surgery (including dental)
    • a planned surgery (including dental) in the next seven days
  • if you have had a clot in an artery of your brain (ischaemic stroke) which occurred within the last seven days
  • if you have kidney or liver disease.

While you are taking Clopidogrel Tablets:

  • You should tell your doctor if a surgery (including dental) is planned
  • You should also tell your doctor immediately if you develop a medical condition (also known as Thrombotic Thrombocytopenic Purpura or TTP) that includes fever and bruising under the skin that may appear as red pinpoint dots, with or without unexplained extreme tiredness, confusion, yellowing of the skin or eyes (jaundice) (see section 4 ‘Possible Side Effects’)
  • If you cut or injure yourself, it may take longer than usual for bleeding to stop. This is linked to the way your medicine works as it prevents the ability of blood clots to form. For minor cuts and injuries e.g., cutting yourself shaving, this is usually of no concern. However, if you are concerned by your bleeding, you should contact your doctor straightaway (see section 4 ‘Possible Side Effects’)
  • Your doctor may order blood tests

Clopidogrel Tablets are not intended for use in children or adolescents.

Taking other medicines

Please tell your doctor or pharmacist if you are taking or have recently taken any other medicines, including medicines obtained without a prescription. Some other medicines may influence the use of Clopidogrel Tablets or vice versa.

You should specifically tell your doctor if you take

  • oral anticoagulants, medicines used to reduce blood clotting
  • a non-steroidal anti-inflammatory medicine, usually used to treat painful and/or inflammatory conditions of muscle or joints
  • heparin or any other injectable medicine used to reduce blood clotting
  • omeprazole, esomeprazole or cimetidine, medicines to treat upset stomach
  • fluconazole, voriconazole, ciprofloxacin, or chloramphenicol, medicines used to treat bacterial and fungal infections
  • fluoxetine, fluvoxamine, or moclobemide, medicines to treat depression
  • carbamazepine, or oxcarbazepine, medicines to treat some forms of epilepsy
  • ticlopidine, other antiplatelet agent.

Taking Clopidogrel Tablets with food and drink

Clopidogrel Tablets may be taken with or without food.

Pregnancy and breast-feeding

It is preferable not to take this product during pregnancy.

If you are pregnant or suspect that you are pregnant, you should tell your doctor or your pharmacist before taking Clopidogrel Tablets. If you become pregnant while taking Clopidogrel Tablets, consult your doctor immediately as it is recommended not to take clopidogrel while you are pregnant.

You should not breast-feed while taking this medicine. If you are breast-feeding or planning to breast-feed, talk to your doctor before taking this medicine.

Ask your doctor or pharamcist for advice before taking any medicine.

Driving and using machines

Clopidogrel Tablets are unlikely to affect your ability to drive or to use machines.

Important information about some of the ingredients in Clopidogrel Tablets

This medicine contains hydrogenated castor oil, which may cause stomach upsets and diarrhoea.

3. HOW TO TAKE CLOPIDOGREL TABLETS

Always take Clopidogrel Tablets exactly as your doctor has told you. You should check with your doctor or pharmacist if you are not sure.

The usual dose is one 75mg tablet of Clopidogrel per day to be taken orally with or without food, and at the same time each day.

You should take Clopidogrel Tablets for as long as your doctor continues to prescribe it.

If you take more Clopidogrel Tablets than you should

Contact your doctor or nearest hospital emergency department because of the increased risk of bleeding.

If you forget to take Clopidogrel Tablets

If you forget to take a dose of Clopidogrel Tablets, but remember within 12 hours of your usual time, take your tablet straight away and then take your next tablet at the usual time.

If you forget for more than 12 hours, simply take the next single dose at the usual time. Do not take a double dose to make up for the forgotten individual doses.

If you stop taking Clopidogrel Tablets

Do not stop the treatment unless your doctor tells you so. Contact your doctor or pharmacist before stopping.

If you have any further questions on the use of this product, ask your doctor or pharamcist.

4. POSSIBLE SIDE EFFECTS

Like all medicines, Clopidogrel Tablets can cause side effects, although not everybody gets them.

The frequency of possible side effects listed below is defined using the following convention:

  • very common (affects more than 1 user in 10)
  • common (affects 1 to 10 users in 100)
  • uncommon (affects 1 to 10 users in 1,000)
  • rare (affects 1 to 10 users in 10,000)
  • very rare (affects less than 1 user in 10,000)
  • not known (frequency cannot be estimated from the available data)

Contact your doctor immediately if you experience:

  • fever, signs of infection or extreme tiredness. These may be due to rare decrease of some blood cells
  • signs of liver problems such as yellowing of the skin and/or the eyes (jaundice), whether or not associated with bleeding which appears under the skin as red pinpoint dots and/or confusion (see section 2 ‘Take special care with Clopidogrel Tablets’)
  • swelling in the mouth or skin disorders such as rashes and itching, blisters of the skin. These may be the signs of an allergic reaction.

The most common side effect reported with Clopidogrel Tablets is bleeding.

Bleeding may occur as bleeding in the stomach or bowels, bruising, haematoma (unusual bleeding or bruising under the skin), nose bleed, blood in the urine. In a small number of cases, bleeding in the eye, inside the head, the lung or the joints has also been reported.

If you experience prolonged bleeding when taking Clopidogrel Tablets

If you cut or injure yourself, it may take longer than usual for bleeding to stop. This is linked to the way your medicine works as it prevents the ability of blood clots to form. For minor cuts and injuries e.g., cutting yourself shaving, this is usually of no concern. However, if you are concerned by your bleeding, you should contact your doctor straightaway (see section 2 ‘Take special care with Clopidogrel Tablets).

Other side effects reported with Clopidogrel Tablets are:

  • Common side effects: Diarrhoea, abdominal pain, indigestion or heartburn.
  • Uncommon side effects: Headache, stomach ulcer, vomiting, nausea, constipation, excessive gas in stomach or intestines, rashes, itching, dizziness, sensation of tingling and numbness.
  • Rare side effects: Vertigo.
  • Very rare side effects: jaundice; severe abdominal pain with or without back pain; fever, breathing difficulties sometimes associated with cough; generalised allergic reactions; swelling in the mouth; blisters of the skin; skin allergy; inflammation of the mouth (stomatitis); decrease in blood pressure; confusion; hallucinations; joint pain; muscular pain; changes in the way things taste.

In addition, your doctor may identify changes in your blood or urine test results.

If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.

5. HOW TO STORE CLOPIDOGREL TABLETS

Keep out of the reach and sight of children.

Do not use Clopidogrel Tablets after the expiry date which is stated on the carton and on the blister, after EXP.

This medicine does not require any special storage conditions. Do not use Clopidogrel Tablets if you notice any visible signs of deterioration.

Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help protect the environment.

6. FURTHER INFORMATION

What Clopidogrel Tablets contain

The active ingredient is clopidogrel. Each tablet contains 75mg of clopidogrel (as hydrochloride).

The other ingredients are: macrogol 6000, microcrystalline cellulose, low substituted hydroxypropyl cellulose, glycerol dibehenate, and castor oil hydrogenated in the tablet core and opadry II (containing iron oxide red (E172), macrogol 4000, polyvinyl alcohol, titanium dioxide (E171) and talc) in the tablet coating.

What Clopidogrel Tablets look like and the contents of the pack

Clopidogrel Tablets are round, pink tablets with bevelled edges. They are supplied in blister strips in a cardboard outer container in pack sizes of 28, 30, 50 and 84 tablets. Not all pack sizes may be marketed.

Marketing Authorisation Holder:

Wockhardt UK Ltd, Ash Road North, Wrexham, LL13 9UF, UK.

Manufacturer:

CP Pharmaceuticals Ltd, Ash Road North, Wrexham, LL13 9UF, UK.

This medicinal product is authorised in the Member States of the EEA under the following names:

  • UK: Clopidogrel 75mg Film-Coated Tablets
  • Ireland: Clopidogrel 75mg Film-Coated Tablets
  • Germany: Clopidogrel 75mg Filmtabletten
  • Poland: Clopidogrel 75mg Tabletki Powlekane
  • Cyprus: Clopidogrel 75mg Film-Coated Tablets
  • Malta: Clopidogrel 75mg Film-Coated Tablets
  • France: Clopidogrel 75mg comprimé pelliculé

Other formats:

To listen to or request a copy of this leaflet in Braille, large print or audio please call, free of charge: 0800 198 5000 (UK Only).

Please be ready to give the following information:

  • Product name: Clopidogrel 75mg Tablets
  • Reference number: PL 29831/0415

This is a service provided by the Royal National Institute of Blind People.

For the Republic of Ireland please call +353 52 6186000

This leaflet was last approved in 02/2011.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

clopidogrel (Plavix)

Brand Names: Plavix

Generic Name: clopidogrel

  • What is clopidogrel (Plavix)?
  • What are the possible side effects of clopidogrel (Plavix)?
  • What is the most important information I should know about clopidogrel (Plavix)?
  • What should I discuss with my healthcare provider before taking clopidogrel (Plavix)?
  • How should I take clopidogrel (Plavix)?
  • What happens if I miss a dose (Plavix)?
  • What happens if I overdose (Plavix)?
  • What should I avoid while taking clopidogrel (Plavix)?
  • What other drugs will affect clopidogrel (Plavix)?
  • Where can I get more information (Plavix)?

What is clopidogrel (Plavix)?

Clopidogrel is used to lower your risk of having a stroke, blood clot, or serious heart problem after you’ve had a heart attack, severe chest pain (angina), or circulation problems.

Clopidogrel may also be used for purposes not listed in this medication guide.

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What are the possible side effects of clopidogrel (Plavix)?

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Clopidogrel increases your risk of bleeding, which can be severe or life-threatening. Call your doctor or seek emergency medical attention if you have bleeding that will not stop, if you have blood in your urine, black or bloody stools, or if you cough up blood or vomit that looks like coffee grounds.

Also call your doctor at once if you have:

  • pale skin, easy bruising, purple spots under your skin or in your mouth;
  • jaundice (yellowing of your skin or eyes);
  • fast heartbeats, shortness of breath;
  • headache, fever, weakness, feeling tired;
  • little or no urination;
  • a seizure; or
  • signs of a blood clot–sudden numbness or weakness, confusion, problems with vision or speech.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What is the most important information I should know about clopidogrel (Plavix)?

You should not use this medicine if you have any active bleeding such as a stomach ulcer or bleeding in the brain.

Clopidogrel increases your risk of bleeding, which can be severe or life-threatening. Call your doctor or seek emergency medical attention if you have bleeding that will not stop, if you have blood in your urine, black or bloody stools, or if you cough up blood or vomit that looks like coffee grounds.

Do not stop taking clopidogrel without first talking to your doctor, even if you have signs of bleeding. Stopping clopidogrel may increase your risk of a heart attack or stroke.

About clopidogrel

Type of medicine An antiplatelet medicine
Used for To prevent clots from forming in blood vessels
Also called Grepid®; Plavix®
Available as Tablets

In your blood there are ‘sticky’ cells called platelets. When you cut yourself, the platelets stick to each other (clot) to seal the wound. Sometimes platelets stick to each other inside an artery – this is called a thrombus. A thrombus can block a blood vessel, and this is often the cause of a stroke or heart attack. This is more likely to happen if the walls of your arteries have areas which have become thickened with fat deposits, or if you have a fast irregular heartbeat.

If a thrombus forms in a blood vessel around your heart, this reduces the flow of blood to your heart. The term acute coronary syndrome (ACS) covers a range of disorders that are caused by this underlying problem. If you have been prescribed clopidogrel because you have ACS, it may mean that you have had a heart attack, or that you have angina pain that is not well controlled.

Clopidogrel reduces the stickiness of platelets, and this helps prevent the platelets from sticking to the inside of an artery and forming a thrombus. This reduces the risk of you having a heart attack or stroke.

Before taking clopidogrel

Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking clopidogrel it is important that your doctor knows:

  • If you are pregnant or breastfeeding.
  • If you have a condition which causes bleeding (such as a stomach ulcer), or if you have recently had surgery or an injury.
  • If you have any problems with the way your liver works or with the way your kidneys work.
  • If you have ever had an allergic reaction to a medicine.
  • If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.

How to take clopidogrel

  • Before you start taking the tablets, read the manufacturer’s printed information leaflet from inside the pack. It will give you more information about clopidogrel and will provide you with a full list of the side-effects which you may experience from taking it.
  • Take the tablets exactly as your doctor tells you to. It is likely you will be prescribed one tablet of 75 mg clopidogrel to take each day. Although there are two strengths of clopidogrel tablets available (75 mg and 300 mg), the higher-strength tablet is only given as a first dose in some conditions.
  • You can take clopidogrel at whatever time of day you find easiest to remember, but take your doses at the same time of day each day. Most people prefer to take it in the morning, as they find this helps them to remember to take it regularly. You can take the tablet either before or after a meal.
  • If you forget to take a dose, take it as soon as you remember. If you do not remember until more than 12 hours after the time the dose should have been taken then skip the forgotten dose. Do not take two doses at the same time to make up for a missed dose.

Getting the most from your treatment

  • Try to keep all your regular appointments with your doctor. This is so your doctor can check on your progress.
  • Before buying or taking any ‘over-the-counter’ medicines, check with your pharmacist if the medicine is safe for you to take. You should not take any medicines which contain aspirin or any anti-inflammatory painkiller such as ibuprofen, unless your doctor has told you otherwise. This is because these medicines can increase the risk of bleeding when they are taken with clopidogrel. Many cold and flu remedies contain aspirin or ibuprofen.
  • If you are due to have an operation or dental treatment, tell the person carrying out the treatment that you are taking clopidogrel. This is because it is possible that any bleeding may take longer than normal to stop.
  • While you are on clopidogrel, it might take longer than normal to stop bleeding if you cut yourself. If this happens and you find it difficult to stop the bleeding, contact your doctor. Also, if you notice any unusual or unexplained bleeding, speak with your doctor about this too.

Can clopidogrel cause problems?

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with clopidogrel. You will find a full list in the manufacturer’s information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.

Common clopidogrel side-effects (these affect less than 1 in 10 people) What can I do if I experience this?
Bleeding, nosebleeds, bruising, bleeding under the skin (blood blisters) Because of the way clopidogrel works, any bleeding may take longer than normal to stop. If this becomes troublesome, let your doctor know
Indigestion, tummy (abdominal) pain, diarrhoea Stick to simple meals – avoid rich or spicy foods

Important: clopidogrel can occasionally cause unwanted effects which are more serious than the ones listed above. Although these occur only rarely, you should contact your doctor for advice if you feel generally unwell or if you experience any other symptoms which you think may be due to the tablets.

How to store clopidogrel

  • Keep all medicines out of the reach and sight of children.
  • Store in a cool, dry place, away from direct heat and light.

Important information about all medicines

Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.

This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.

Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.

If you have any questions about this medicine ask your pharmacist.

Blood Thinners and Greens: A Mix to Avoid?

Jef L’Ecuyer 12 September, 2016 Cholesterol, Heart Health, Vegetables

You might have heard that if you take an anticoagulant (blood thinner), like Coumadin (warfarin), you should stop eating, or at least eat fewer, green vegetables, because they contain too much Vitamin K. But is this really the case?

Before getting right into the topic, let’s review some basics. Firstly, it’s important to note that Coumadin (generic name: warfarin) is an anticoagulant, which means it stops the formation of blood clots and makes blood thinner (less viscous). As for Vitamin K, it helps the process of blood clotting. In other words, warfarin has the opposite effect to Vitamin K.

What is INR (International Normalized Ratio)? And how does it vary?

The INR is a test used by doctors and pharmacists to check the effectiveness of blood thinning medication (Coumadin/warfarin) and to adapt the dosage. Ideally, you should maintain as stable an INR as possible, meaning you should maintain an optimal blood coagulation rate.

Several factors can influence and unbalance this rate, the seven main ones are:

  • Travelling
  • Moving home
  • Depression
  • Divorce
  • Bereavement
  • Malnutrition
  • Dementia

Other factors include genetics, diet, adherence to treatment and other medications you may be taking. Natural supplements are included in the list of medicines that can affect INR.

Natural Supplements and Anticoagulation Therapy

For your information, here are a few examples of natural products that could influence your INR more than eating green vegetables:

  • Those which increase INR values:
    • Boldo and fenugreek
    • Cranberry juice (in large quantities)
    • Danshen
    • Devil’s Claw
    • Dong Quai
    • Garlic capsules
    • Ginger
    • Ginko biloba
    • Mayweed
    • Papain
    • Vitamin E (in doses larger than 400 units/day)
  • Those which reduce INR values:
    • Coenzyme Q10
    • Ginseng
    • Green tea (in large quantities)
    • St. John’s Wort

Always speak to your pharmacist before you start or stop taking a supplement. If you take supplements, make sure you tell your doctor and your pharmacist.

Now that we’re reviewed some basic facts, let’s get to the nitty gritty: diet and its effect on medication! Several vegetables, particularly green ones, contain Vitamin K, in varying quantities. As mentioned earlier, warfarin (Coumadin) is a Vitamin K antagonist. Its presence or absence from the diet can play a role in the medication’s effectiveness.

Why You Shouldn’t Avoid Green Vegetables

Two main reasons can explain why reducing your intake of green vegetables is not necessary, even if you’re going through anticoagulation therapy.

Firstly, despite what you might have heard, the presence of Vitamin K in the diet helps better balance your INR. Indeed, regularly eating vegetables, particularly green ones, helps you to be less sensitive to daily variations in Vitamin K. This is explained by the fact the liver stocks some Vitamin K, because it is a fat soluble vitamin.

For example, if you eat green vegetables every day, your liver stores Vitamin K. If, one day, you have a lower intake of Vitamin K, this will have practically no repercussions. Vitamin K stored in the liver will be used. This way, you can maintain you INR as stable as possible. However, if you never eat green vegetables, you don’t have Vitamin K stores, so if you eat a good amount of green vegetables one day, you’ll experience a “peak” of Vitamin K, which will then destabilize your INR.

Secondly, Vitamin K’s bioavailability depends on several factors like cultivation, storage and cooking of foods. What’s more, we only know the Vitamin K content of around half the food in the North American diet. It’s therefore practically impossible to establish and respect a recommended daily intake of Vitamin K.

For these reasons, we recommend an intake of 1 to 2 portions of green vegetables each day, even for those taking Coumadin. This quantity enables you to have a better control of your medication and to meet the nutritional needs established by Health Canada. What’s more, green vegetables are great for health!

Note: if you are a fan of Asian cuisine and regularly eat natto (a traditional Japanese food made from fermented soya beans), it would be a good idea to avoid it, because it contains a large quantity of Vitamin K (much higher than what is commonly found in vegetables), which can influence your INR.

Main food sources of Vitamin K

So, in answer to the original question, no, it isn’t necessary to avoid green vegetables because the Vitamin K they contain enables a better control of both coagulation and medication. Good to know, those who have the most difficulty managing their INR are often those who do not eat (or do not eat enough) Vitamin K and green vegetables.

Our heart-healthy menus are approved by the nutritionists at EPIC, Montreal Heart Institute’s Center for Preventative Medicine, even for their anticoagulation therapy patients. Why not give them a try to help plan your meals?

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Jef L’Ecuyer

Registered Dietitian, RD at SOScuisine.com Member of the Quebec College of Dietitians (OPDQ) and Dietitians of Canada,Jef graduated from McGill University in December 2014. Recently graduated and passionate about culinary arts, Jef poses a simple, effective and practical look at daily meal planning. With this in mind, she works in conjunction with the mission of SOSCuisine…

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