Prevention of atherothrombotic events in patients suffering from MI (from a few days until <35 days), ischaemic stroke (from 7 days until <6 mth), established peripheral arterial disease; non-ST segment elevation acute coronary syndrome (ACS) (unstable angina or non-Q-wave MI); ST segment elevation acute MI in combination w/ ASA in patients eligible for thrombolytic therapy; patients undergoing a stent placement following percutaneous coronary intervention, in combination w/ ASA; prevention of atherothrombotic & thromboembolic events including stroke in atrial fibrillation (AF).
Adult & elderly 75 mg once daily. Non-ST segment elevation ACS (unstable angina or non-Q-wave MI) Initially 300 mg then 75 mg once daily (w/ ASA 75-325 mg daily). ST segment elevation acute MI Initially 75 mg as a single dose w/ or w/o loading dose (w/ ASA & w/ or w/o thrombolytics). Patient >75 yr Initiate w/o a loading dose. AF 75 mg as a single dose (w/ ASA 75-100 mg daily).
Patients at risk of increased bleeding from trauma, surgery or other pathological conditions. Patients who have lesions w/ a propensity to bleed (particularly GI & intraocular). Patients who are CYP2C19 poor metabolisers. Patients w/ severe hepatic disease who may have bleeding diatheses. Patients w/ galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption. Thrombotic thrombocytopenic purpura. Discontinue if acquired haemophilia occurs. Cross-reactivity among thienopyridines. Discontinue 5-7 days prior to surgery. Renal impairment. Pregnancy. Childn <18 yr. Combination w/ ASA in recent transient ischaemic attack/stroke patients.
Increased risk of bleeding w/ warfarin. Pharmacodynamic interaction w/ glycoprotein IIb/IIIa inhibitors & ASA. Injectable anticoagulants, thrombolytics. Increased occult GI blood loss w/ naproxen; other NSAIDs including COX-2 inhibitors. Platelet activation may be affected w/ SSRIs. Reduced drug levels of active metabolite w/ CYP2C19 inhibitors (eg, omeprazole).
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