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Blood thinners - clopidogrel; Antiplatelet therapy - clopidogrel

Treatment with clopidogrel prevents blood clots from forming in your arteries. This medicine helps reduce your risk of stroke or heart attack.

Clopidogrel may be used to:

• Prevent or treat heart attacks
• Prevent stroke or transient ischemic attacks, or TIAs (early warning signs of stroke also called "mini-strokes")
• Increase blood flow to your legs
• Prevent clots form forming inside stents

This medicine is usually taken as a pill. Your doctor may change your dose from time to time.

See also: Aspirin and heart disease

Side effects of this medicine may include diarrhea, skin rash, itching, nausea, or stomach pain. Before you start taking clopidogrel, tell your doctor if:

• You have bleeding problems or stomach ulcers.
• You are pregnant, plan to become pregnant, or are breastfeeding.

Take this medicine with food and plenty of water to lower side effects. You may need to stop taking clopidogrel before you have surgery or dental work. Do NOT just stop taking your medicine without talking with your doctor or nurse first.

Talk with your doctor before taking any of these drugs:

• Heparin and other blood thinners, such as warfarin (Coumadin)
• Pain or arthritis medicine (such as diclofenac, etodolac, ibuprofen, indomethacin, Advil, Aleve, Daypro, Dolobid, Feldene, Indocin, Motrin, Orudis, Relafen, or Voltaren)
• Phenytoin (Dilantin), tamoxifen (Nolvadex), tolbutamide (Orinase), or torasemide (Demadex)

Do not take other drugs that may have aspirin or ibuprofen in them. Read the labels on cold and flu medicines. Ask your doctor what other medicines are safe for you to take for aches and pains, colds, or the flu.

Tell your doctor if you are pregnant or planning to become pregnant, or breastfeeding or planning to breastfeed. Women in the later stages of pregnancy should not take clopidogrel. Clopidogrel can also be passed to infants through breast milk.

If you miss a dose:

• Take it as soon as possible, unless it is time for your next dose.
• If it is time for your next dose, take your usual amount.
• Do NOT take extra pills to make up for a dose you have missed.

Store these drugs and all other medicines in a cool, dry place. Keep them where children cannot get to them.

Call your doctor if you have any of these side effects and they do not go away:

• Any signs of unusual bleeding, such as blood in the urine or stools, nosebleeds, any unusual bruising, heavy bleeding from cuts, black tarry stools, coughing up blood, heavier than usual menstrual bleeding or unexpected vaginal bleeding, vomit that looks like coffee grounds
• Dizziness
• Difficulty swallowing
• Tightness in your chest or chest pain
• Swelling in your face or hands
• Itching, hives, or tingling in your face or hands
• Wheezing or difficulty breathing
• Very bad stomach pain
• Skin rash

Tran H, Anand SS. Oral antiplatelet therapy in cerebrovascular disease, coronary artery disease, and peripheral arterial disease. JAMA October 20, 2004; 292:1867-74.