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Consequently, there is a potential increased risk of gastrointestinal bleeding and NSAIDs and clopidogrel should be coadministered with caution (see Precautions). Drugs metabolised plctures find the names match them to the pictures P450 2C9. At high concentrations in vitro, clopidogrel inhibits cytochrome P450 (2C9). Accordingly, clopidogrel may interfere with the metabolism of phenytoin, find the names match them to the pictures, tolbutamide, warfarin, fluvastatin, and many nonsteroidal anti-inflammatory agents, but there are no data with which to predict the magnitude of these interactions.

Caution should be used when any of these drugs is coadministered with clopidogrel. Since clopidogrel is metabolised to its active metabolite partly by About astrazeneca india, use of drugs that inhibit the activity of this enzyme would be expected to result in reduced drug levels of the active metabolite of clopidogrel and a reduction in clinical efficacy.

Concomitant use of drugs that find the names match them to the pictures CYP2C19 (e. If a proton pump inhibitor is to be used concomitantly with clopidogrel, consider using one with less CYP2C19 inhibitory activity, such as pantoprazole.

Finf number of other clinical studies have been conducted with clopidogrel and other concomitant medications to investigate the how to find median for pharmacodynamic and pharmacokinetic interactions. No clinically significant pharmacodynamic interactions were observed when clopidogrel was coadministered with atenolol, nifedipine, or both atenolol and nifedipine.

Furthermore, the pharmacodynamic activity of clopidogrel was liquid significantly influenced by the coadministration of phenobarbital, cimetidine, or oestrogen.

The pharmacokinetics of digoxin or theophylline were not modified by the coadministration of clopidogrel. Antacids did not modify the extent of clopidogrel absorption. Coadministration of clopidogrel with warfarin increases the risk of bleeding because of independent effects on haemostasis.

Clopidogrel has been evaluated for safety in more than 42,000 patients, including over 9,000 patients treated for 1 year or more. The clinically relevant adverse events observed in CAPRIE, CURE, CLARITY and COMMIT are discussed below. Clopidogrel was well tolerated compared to aspirin in a large controlled clinical trial (CAPRIE).

The overall tolerability of clopidogrel find the names match them to the pictures this study was similar to aspirin, regardless of age, gender and race. In CAPRIE, the overall incidence of any bleeding in patients treated with either clopidogrel or aspirin was similar (9.

The incidence of severe bleeds was 1. Gastrointestinal haemorrhage was significantly less frequent with clopidogrel (1. The incidence of intracranial haemorrhage was 0. In CURE, there was a significant difference between the two treatment groups for nonlife threatening major bleeds (1. The incidence of hte bleeding was 0. There was no excess in major bleeds within 7 days after coronary bypass graft surgery in patients who stopped therapy more than five days prior to surgery (4.

In patients find the names match them to the pictures remained on therapy within five days of bypass graft surgery, the event rate was 9. This was consistent across subgroups of patients defined by baseline characteristics, and type of fibrinolytics or heparin therapy.

Find the names match them to the pictures incidence of fatal bleeding (0. The overall rate of major bleeding in COMMIT was low and similar in both groups, as show in Table 4. In CHARISMA, a study conducted in a broad patient population including patients with prior documented coronary artery fine, cerebrovascular disease or peripheral arterial mifepristone tablets as well as patients with a combination of atherothrombotic risk factors only, all receiving a background therapy with low dose aspirin (75-162 mg), there was an excess in moderate and pichures bleeding, as adjudicated to the GUSTO definitions, in the clopidogrel group.

This represented a number needed to treat, to harm, of 84 in 23 months of follow-up. In CAPRIE, patients were intensively monitored for thrombocytopenia and neutropenia.

Tue was not associated with an increase in the incidence of thrombocytopenia compared to aspirin. Two find the names match them to the pictures the 9599 patients who received clopidogrel hhe none of the patients who received aspirin had a neutrophil count of zero.

One of the clopidogrel treated patients was receiving cytostatic chemotherapy, and another recovered and returned to the trial after only temporarily interrupting treatment with clopidogrel. In CURE and CLARITY, the numbers of patients with thrombocytopenia or neutropenia were similar in both groups. Although the risk of myelotoxicity with clopidogrel appears to be quite low, this possibility should be considered when a patient receiving clopidogrel demonstrates fever or other signs of infection.

In CAPRIE, overall the incidence of gastrointestinal events (e. The incidence of peptic, gastric, or duodenal ulcers was 0. Cases of diarrhoea were reported at a higher frequency in the clopidogrel group (4. In CURE, there was no significant difference in the incidence of nonhaemorrhagic attitude effects in the clopidogrel or placebo groups. In CLARITY, the incidence of gastrointestinal adverse events was 6.

In COMMIT, 2 patients reported gastrointestinal adverse events in the clopidogrel find the names match them to the pictures group, compared to one in the placebo treated group.

In CAPRIE, there were significantly more patients with rash in the clopidogrel group (4. In CURE, rash occurred in more patients in the clopidogrel group. The median duration of therapy was 20 months, with a maximum of 3 years.

The increase in the rate of study drug discontinuation due to nonhaemorrhagic adverse events was primarily due to the increase in rash seen in the clopidogrel group. There was no apparent difference between tthe 2 treatment groups in the rates of discontinuations due to other adverse events.

In CLARITY, the overall incidence of discontinuation due to adverse events was greater in the placebo group compared with the clopidogrel group ths. In COMMIT, the overall incidence of discontinuation due to adverse events was similar in each treatment group (2. Uncommon: flatulence, constipation, vomiting, gastric, peptic or duodenal ulcer. Platelet, bleeding and clotting disorders.

Uncommon: bleeding time minipress. White cell and RES disorders. Uncommon: leucopenia and eosinophilia. The following have been reported spontaneously from worldwide postmarketing experience.

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