The simultaneous use of warfarin with clopidogrel may increase the intensity of bleeding, so the use of this combination is not recommended.
The appointment of inhibitors of glycoprotein IIb / IIIa, ASA, heparin in conjunction with clopidogrel increases the risk of bleeding.
In an application with fluoxymesterone halotestinmay increase the risk of bleeding .
Simultaneous treatment with inhibitors (eg omeprazole) is not recommended.
The active metabolite inhibits isozyme klopidorgela, whereby the concentration can be increased phenytoin, tolbutamide and in plasma.
During treatment necessary to monitor the performance of the system hemostasis (activated partial thromboplastin time (aPTT), platelet count, platelet function tests); regularly examine the functional activity of the liver.
Clopidogrel should be used with caution in patients with risk of major bleeding in trauma, surgery, in patients who have lesions that are prone to bleed (particularly gastrointestinal and intraocular), as well as in patients receiving fluoxymesterone halotestin (including COX-2) inhibitors, heparin or glycoprotein IIb / IIIa. Patients must be carefully monitored to detect any signs of bleeding, including latent, especially during the first weeks of the drug and / or after invasive cardiac procedures or surgeries. Concomitant use is not recommended clopidogrel and warfarin, because it may increase bleeding.
In the case of surgery if antiplatelet effect is not desired, treatment should be discontinued 7 days before surgery.
Patients should be warned that as a stop occurring during treatment with clopidogrel ( in combination with or without ACK) bleeding requires more time, they must inform the doctor about each occurrence of bleeding. Patients should also inform your doctor about taking medication if they are to surgery.
After receiving clopidogrel thrombotic thrombocytopenic purpura (TTP) is found very rarely, sometimes after a short use. This condition is characterized by thrombocytopenia and microangiopathic hemolytic anemia, combined with neurological signs, renal or fever function.
TTP – a potentially fatal condition that requires immediate medical treatment, including the use of plasmapheresis.
Clopidogrel can not be recommended due to lack of data in acute (less than 7 days), ischemic stroke.
experience with clopidogrel fluoxymesterone halotestin in patients with renal impairment is limited, therefore these patients clopidogrel should be used with caution.
in severe hepatic dysfunction should be aware of the risk of hemorrhagic diathesis, the experience of the drug in patients with moderate hepatic impairment, limited so these patients, clopidogrel should be used with caution.
The ability to drive a vehicle.
Clopidogrel may cause side effects in the nervous system (headache, dizziness, vertigo, confusion, hallucinations), which may affect the ability to drive and to classes in other potentially hazardous activities that require high concentration and psychomotor speed reactions.