Clopidogrel (Loading Dose)

Other regimens stated in SPC section 4.2: ST-segment elevation MI, medically treated and eligible for thrombolytic/fibrinolytic therapy - 75 mg once daily initiated with a 300 mg loading dose in combination with ASA, with or without thrombolytics; in patients over 75 years of age clopidogrel should be initiated WITHOUT a loading dose; combined therapy started as early as possible after symptom onset and continued for at least four weeks. When PCI is intended - 600 mg loading dose for primary PCI and for PCI more than 24 hours after fibrinolytic therapy (in patients >=75 years the 600 mg loading dose should be administered with caution); 300 mg loading dose for PCI within 24 hours of fibrinolytic therapy; then 75 mg once daily with ASA 75-100 mg daily, continued up to 12 months. Moderate-to-high-risk TIA (ABCD2 >=4) or minor ischaemic stroke (NIHSS <=3) - loading dose 300 mg then 75 mg once daily plus ASA 75-100 mg once daily, started within 24 hours of the event and continued for 21 days, followed by single antiplatelet therapy. Atrial fibrillation - 75 mg once daily with ASA 75-100 mg daily. Optimal duration of treatment in ACS has not been formally established; clinical trial data support use up to 12 months with maximum benefit at 3 months. Missed dose: if less than 12 hours after the scheduled time, take immediately then resume schedule; if more than 12 hours, take the next dose at the scheduled time and do not double the dose. Paediatric population - the SPC states clopidogrel should NOT be used in children because of efficacy concerns. Section 4.4 states the 600 mg loading dose is not recommended in patients with non-ST segment elevation ACS aged >=75 years due to increased bleeding risk, and that clopidogrel should be discontinued 7 days before elective surgery if antiplatelet effect is temporarily not desirable.