Antiplatelet — P2Y12 Inhibitor Pregnancy: As no clinical data on exposure during pregnancy are available, it is preferable not to use clopidogrel during pregnancy as a precautionary measure; animal studies do not indicate direct or indirect harmful effects on pregnancy, embryonal/foetal development, parturition or postnatal development. It is unknown whether clopidogrel is excreted in human breast milk (animal studies show excretion in milk); as a precautionary measure breast-feeding should not be continued during treatment.

Clopidogrel (Elderly)

Brand names: Plavix

Clopidogrel is an oral antiplatelet (a thienopyridine P2Y12 inhibitor) used to prevent atherothrombotic events after acute coronary syndromes, stenting and ischaemic stroke or peripheral arterial disease; this page concerns its use in older patients.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Adults and elderly: a single daily dose of 75 mg. In acute coronary syndrome a loading dose is used first - NSTE-ACS (unstable angina or non-Q-wave MI): a single 300 mg or 600 mg loading dose (a 600 mg loading dose may be considered in patients under 75 years of age when PCI is intended), then 75 mg once daily with aspirin 75-325 mg daily (aspirin recommended not to exceed 100 mg because higher doses carry higher bleeding risk). STEMI, medically treated patients eligible for thrombolytic/fibrinolytic therapy: 75 mg once daily initiated with a 300 mg loading dose, but in medically treated patients OVER 75 YEARS OF AGE clopidogrel should be initiated WITHOUT a loading dose.

Route: Oral - may be given with or without food

Frequency: Once daily

ELDERLY-SPECIFIC STATEMENTS (section 4.2 special populations and section 4.4): in NSTE-ACS a 600 mg loading dose may be considered only in patients under 75 years when PCI is intended, and the 600 mg loading dose is NOT recommended in patients with NSTE-ACS aged 75 years or over because of increased bleeding risk; in medically treated STEMI patients over 75 years eligible for thrombolysis, initiate without a loading dose; in patients aged 75 years or over undergoing primary PCI or PCI more than 24 hours after fibrinolytic therapy, the 600 mg loading dose should be administered with caution. WHEN PCI IS INTENDED (STEMI): 600 mg loading dose in primary PCI and in PCI more than 24 hours after fibrinolytic therapy; 300 mg loading dose in PCI within 24 hours of fibrinolytic therapy; then continue 75 mg once daily with aspirin 75-100 mg daily, started as early as possible after symptom onset and continued up to 12 months. DURATION: in NSTE-ACS the optimal duration has not been formally established - trial data support use up to 12 months with maximum benefit at 3 months; in medically treated STEMI, combined therapy should start as early as possible and continue for at least four weeks (benefit beyond four weeks not studied). MODERATE-TO-HIGH-RISK TIA (ABCD2 score 4 or more) OR MINOR ISCHAEMIC STROKE (NIHSS 3 or less): loading dose of 300 mg, then 75 mg once daily with aspirin 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 as a single dose, with aspirin 75-100 mg daily initiated and continued in combination. MISSED DOSE: if less than 12 hours after the scheduled time, take immediately and take the next dose at the regular time; if more than 12 hours, take the next dose at the regular time and do not double the dose. SURGERY: if antiplatelet effect is temporarily undesirable before elective surgery, discontinue clopidogrel 7 days beforehand. HEPATIC IMPAIRMENT: therapeutic experience is limited in moderate hepatic disease (bleeding diatheses possible); severe hepatic impairment is contraindicated. PAEDIATRIC: clopidogrel should not be used in children because of efficacy concerns - no paediatric dose is stated.

Dose adjustments

Renal

Therapeutic experience is limited in patients with renal impairment (section 4.2). US label cross-check: no dosage adjustment is necessary in elderly patients.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to clopidogrel or to any of the excipients
Severe hepatic impairment
Active pathological bleeding such as peptic ulcer or intracranial haemorrhage

Side effects

Bleeding - the most common adverse reaction in both clinical studies and post-marketing use, mostly reported during the first month of treatment (overall incidence of any bleeding 9.3% in CAPRIE)
Gastrointestinal bleeding (3.5% with clopidogrel plus aspirin versus 1.8% with placebo plus aspirin in ACTIVE-A)
Intracranial bleeding (1.4% with clopidogrel plus aspirin versus 0.8% with placebo plus aspirin in ACTIVE-A)
Thrombotic thrombocytopenic purpura (TTP) - reported very rarely, sometimes after short exposure; potentially fatal and requires prompt treatment including plasmapheresis
Acquired haemophilia - reported following use of clopidogrel
Haematological adverse reactions - blood cell count determination should be considered whenever symptoms suggestive of bleeding arise
NOTE: the tabulated section 4.8 adverse reaction list was truncated in the fetched text; the entries above are drawn from the section 4.8 safety-profile narrative and section 4.4

Interactions

Aspirin, heparin, glycoprotein IIb/IIIa inhibitors, NSAIDs including COX-2 inhibitors, SSRIs, and other medicinal products associated with bleeding risk such as pentoxifylline - use clopidogrel with caution, increased bleeding risk (section 4.4)
Oral anticoagulants - concomitant administration is not recommended as it may increase the intensity of bleeding (section 4.4)
Triple antiplatelet therapy (clopidogrel plus aspirin plus dipyridamole) for stroke secondary prevention - not recommended in acute non-cardioembolic ischaemic stroke or TIA due to increased haemorrhage risk (section 4.4)
Strong CYP2C19 inducers - increased bleeding risk; use clopidogrel with caution (section 4.4)
US label cross-check: avoid concomitant use of omeprazole or esomeprazole (both significantly reduce the antiplatelet activity of clopidogrel)
US label cross-check: opioids decrease exposure to clopidogrel - consider a parenteral antiplatelet agent
NOTE: the SPC section 4.5 interactions section itself was not captured in this bundle; the UK entries above are drawn from section 4.4

Clinical monograph

How it works

It is a prodrug whose active metabolite irreversibly blocks the platelet P2Y12 ADP receptor, inhibiting ADP-mediated platelet activation and aggregation for the platelet's lifespan.

Prescribing in practice

Bleeding risk is the principal hazard and rises with age and comorbidity, so assess bleeding risk, review concurrent anticoagulants, NSAIDs and other antiplatelets, and stop in advance of elective surgery as advised.
Co-prescribe gastroprotection where bleeding risk is high, preferring a proton pump inhibitor that does not strongly inhibit CYP2C19 (avoid omeprazole and esomeprazole).
Activation depends on CYP2C19, so response may be reduced by interacting drugs and in poor metabolisers.

Monitoring

There is no routine laboratory monitoring; monitor clinically for bleeding, bruising and anaemia, especially in frail older patients.

Counselling the patient

Report unusual bruising, black stools, or bleeding that does not stop, and any blood in urine or vomit.
Tell every clinician and dentist you take an antiplatelet before procedures.
Do not stop the medicine without advice, particularly after a recent stent.

Evidence & guidelines

Benefit is supported by trials including CAPRIE and CURE and reflected in NICE guidance on antiplatelet therapy.

Reference: NICE NG185; CAPRIE trial; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways