CLOPIDOGREL

Clopidogrel 75 mg equivalent clopidogrel hydrogen sulphate 97.875 mg

Plavix (clopidogrel bisulfate) is an inhibitor of ADP-induced platelet aggregation acting by direct inhibition of adenosine diphosphate (ADP) binding to its receptor and of the subsequent ADP-mediated activation of the glycoprotein GPIIb/IIIa complex. Chemically it is methyl (+)-(S)-α-(2-chlorophenyl)-6,7-dihydrothieno[3,2-c]pyridine-5(4H)-acetate sulfate (1:1). The empirical formula of clopidogrel bisulfate is C₁₆H₁₆C_lNO₂S•H₂SO₄ and its molecular weight is 419.9.

The structural formula is as follows:

 

Plavix (clopidogrel bisulfate) is indicated for the reduction of atherothrombotic events as follows:

• Recent MI, Recent Stroke or Established Peripheral Arterial Disease
  For patients with a history of recent myocardial infarction (MI), recent stroke, or established peripheral arterial disease, Plavix has been shown to reduce the rate of a combined endpoint of new ischemic stroke (fatal or not), new MI (fatal or not), and other vascular death.
• Acute Coronary Syndrome
  For patients with non-ST-segment elevation acute coronary syndrome (unstable angina/non-Q-wave MI) including patients who are to be managed medically and those who are to be managed with percutaneous coronary intervention (with or without stent) or CABG, Plavix has been shown to decrease the rate of a combined endpoint of cardiovascular death, MI, or stroke as well as the rate of a combined endpoint of cardiovascular death, MI, stroke, or refractory ischemia.
  For patients with ST-segment elevation acute myocardial infarction, Plavix has been shown to reduce the rate of death from any cause and the rate of a combined endpoint of death, re-infarction or stroke. This benefit is not known to pertain to patients who receive primary angioplasty.

DOSAGE

ADULT and Ederly

Just single daily of 75 mg clopidogrel with or without food

Non-ST segment elevation (unstable angina/non-Q-wave MI) should be initiated with a single 300-mg loading dose and then continued at 75 mg once daily. Aspirin (75 mg-325 mg once daily) should be initiated and continued in combination with Plavix.

in Indonesian country only have

PLAVIX 75 MG( sanofi) contain 30’s tablet/box

and now there is other competitor such as

CPG 75 MG

I am glad now ,for clopidogrel(plavix) is include in packed ASKES( Asuransi kesehatan) from Indonesia.

http://medical-only.blogspot.com

Viagra

Trade name of an orally administered drug for erectile failure first cleared for marketing in the United States in March 1998. Its generic name is sildenafil citrate.
Mentioned in: Impotence
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.

trademark for a preparation of sildenafil citrate, a treatment for erectile dysfunction.
Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier.
sildenafil citrate

Revatio, Viagra

Pharmacologic class: Phosphodiesterase type 5 (PDE5) inhibitor

Therapeutic class: Anti-erectile dysfunction agent

Pregnancy risk category B
Action

Inhibits PDE5, enhancing the effects of nitric oxide released during sexual stimulation. This action inactivates cyclic guanosine monophosphate (cGMP), which then increases cGMP levels in corpus cavernosum. Resulting smooth muscle relaxation promotes increased blood flow and subsequent erection.
Availability

Tablets: 25 mg, 50 mg, 100 mg

⊘Indications and dosages

➣ Erectile dysfunction

Adults: 50 mg P.O., preferably 1 hour before anticipated sexual activity. Range is 25 to 100 mg taken 30 minutes to 4 hours before sexual activity, not to exceed one dose daily.
Dosage adjustment

• Hepatic or renal impairment
• Concurrent use of hepatic isoenzyme inhibitors (such as cimetidine, erythromycin, itraconazole, ketoconazole)
• Elderly patients
Contraindications

• Hypersensitivity to drug
• Concurrent use of nitrates (nitroglycerin, isosorbide mononitrate or dinitrate)
Precautions

Use cautiously in:
• serious cardiovascular disease (such as history of myocardial infarction, cerebrovascular accident, or serious arrhythmia within past 6 months); coronary artery disease (current or previous) with unstable angina; resting blood pressure below 90/50 mm Hg or above 170/110 mm Hg (current or previous); heart failure (current or previous); renal or hepatic impairment (current or previous); bleeding disorder; active peptic ulcer; anatomic penile deformity; retinitis pigmentosa; conditions associated with priapism (sickle cell anemia, multiple myeloma, leukemia)
• history of uncontrolled hypertension or hypotension
• concurrent use of antihypertensives, erythromycin, ketoconazole, itraconazole, or saquinavir
• patients older than age 65.
Administration

☞ Don't give concurrently with nitrates.
• Administer 30 minutes to 4 hours before sexual activity.
Route Onset Peak Duration
P.O. Within 1 hr Unknown Up to 4 hr
Adverse reactions

CNS: headache, dizziness, anxiety, drowsiness, vertigo, seizures , cerebrovascular hemorrhage, transient ischemic attack

CV: hypertension, myocardial infarction (MI), cardiovascular collapse, ventricular arrhythmias, sudden death

EENT: transient vision loss, blurred or color-tinged vision, increased light sensitivity, ocular redness, retinal bleeding, vitreous detachment or traction, photophobia, nasal congestion

GI: diarrhea, dyspepsia

GU: hematuria, urinary tract infection, priapism

Skin: flushing, rash
Interactions

Drug-drug. Antihypertensives, nitrates: increased risk of hypotension

Enzyme inducers, rifampin: reduced sildenafil blood level

Hepatic isoenzyme inhibitors (such as cimetidine, erythromycin, itraconazole, ketoconazole), protease inhibitors (such as indinavir, nelfinavir, ritonavir, saquinavir): increased sildenafil blood level and effects

Drug-food. High-fat diet: reduced drug absorption, decreased peak level
Patient monitoring

• Monitor cardiovascular status carefully.
• Evaluate patient's vision.
• Assess for drug efficacy.
Patient teaching

• Advise patient to take 30 minutes to 4 hours before sexual activity.
• Tell patient not to exceed prescribed dosage or take more than one dose daily.
☞ Instruct patient to stop sexual activity and contact prescriber immediately if chest pain, dizziness, or nausea occurs.
☞ Teach patient to recognize and immediately report serious cardiac and vision problems.
• Inform patient that drug can cause serious interactions with many common drugs. Instruct him to tell all prescribers he's taking it.
☞ Caution patient never to take drug with nitrates, because of risk of potentially fatal hypotension.
• Instruct patient to report priapism (persistent, painful erection) or erections lasting more than 4 hours.
• Tell patient that high-fat diet may interfere with drug efficacy.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and foods mentioned above.