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Clopidogrel is extensively metabolized by two main metabolic pathwaysone mediated by esterases and leading to hydrolysis into an inactive carboxylic acid derivative85of circulating metabolitesand one mediated by multiple cytochrome P450 enzymesCytochromes first oxidize clopidogrel to a 2-oxo-clopidogrel intermediate metaboliteSubsequent metabolism of the 2-oxoclopidogrel intermediate metabolite results in formation of the active metabolitea thiol derivative of clopidogrelThe active metabolite is formed mostly by CYP2C19 with contributions from several other CYP enzymesincluding CYP1A2CYP2B6 and CYP3AThe active thiol metabolite binds rapidly and irreversibly to platelet receptorsthus inhibiting platelet aggregation for the lifespan of the platelet.
Since selective serotonin reuptake inhibitorsSSRIsand serotonin norepinephrine reuptake inhibitorsSNRIsaffect platelet activationthe concomitant administration of SSRIs and SNRIs with clopidogrel may increase the risk of bleeding.
The trial’s primary outcome was the time to first occurrence of new ischemic strokefatal or notnew cialis 50 mg. myocardial infarctionfatal or notor other vascular deathDeaths not easily attributable to nonvascular causes were all classified as vascular.
LactationNot known whether drug is excreted in human haldol with no prescription. milkbecause many drugs are excreted in human milk and because of potential for serious adverse reactions in nursing infants from clopidogrela decision should be made whether to discontinue nursing or to discontinue drugtaking into account importance of drug to mother.
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