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purpura,
agranulocytosis and pancytopenia),
and
hypersensitivity-like reactions (including fever,
glo-
merulonephritis,
arthralgia,
Stevens-Johnson
syndrome,
toxic epidermal necrolysis,
lichen planus)
Dose
. Prevention of artherosclerotic events in peripheral
arterial disease or after myocardial infarction or
ischaemic stroke,
75 mg once daily
. Acute coronary syndrome (without ST-segment ele-
vation), initially 300 mg then 75 mg daily (with
aspirin—see notes above)
. Acute myocardial infarction (with ST-segment eleva-
tion), initially 300 mg then 75 mg daily (with aspirin—
see notes above); initial dose omitted if patient over
75 years
Clopidogrel
(Non-proprietary) A
Tablets
,
clopidogrel (as besilate or hydrochloride)
75 mg,
net price 28-tab pack = £3.17,
30-tab pack =
£3.40
Brands include
Grepid
c
Plavix
c
(Sanofi-Aventis) A
Tablets
,
pink, f/c, clopidogrel (as hydrogen sulphate)
75 mg, net price 30-tab pack = £35.64; 300 mg, 30-tab
pack = £142.54
DIPYRIDAMOLE
Indications
see notes above and under Dose
Cautions
rapidly worsening angina,
aortic stenosis,
recent myocardial infarction,
left ventricular outflow
obstruction,
heart failure;
may exacerbate migraine;
hypotension; myasthenia gravis (risk of exacerbation);
coagulation disorders;
concomitant use of drugs that
increase risk of bleeding;
interactions: Appendix 1
(dipyridamole)
Pregnancy
not known to be harmful
Breast-feeding
manufacturers advise use only if
essential—small amount present in milk
Side-effects
gastro-intestinal effects,
dizziness,
myal-
gia, throbbing headache, hypotension, hot flushes and
tachycardia; worsening symptoms of coronary heart
disease;
hypersensitivity reactions such as rash,
urti-
caria,
severe bronchospasm and angioedema;
increased bleeding during or after surgery;
thrombo-
cytopenia reported
Dose
. By mouth,
300–600 mg daily in 3–4 divided doses
Modified-release preparations,
see under preparation
below
. By intravenous injection,
diagnostic only,
consult
product literature
Dipyridamole
(Non-proprietary) A
Tablets
,
coated,
dipyridamole 25 mg,
net price 84 =
£3.11;
100 mg,
84 = £2.80.
Label:
22
Oral suspension
,
dipyridamole 50 mg/5 mL,
net
price 150 mL = £40.63
Persantin
c
(Boehringer Ingelheim) A
Tablets
,
s/c,
dipyridamole 25 mg (orange),
net price
84-tab pack = £1.49;
100 mg,
84-tab pack = £4.16.
Label:
22
Injection
,
dipyridamole 5 mg/mL,
net price 2-mL
amp = 12p
Modified release
Persantin
c
Retard
(Boehringer Ingelheim) A
Capsules
, m/r, red/orange containing yellow pellets,
dipyridamole 200 mg,
net price 60-cap pack = £9.00.
Label:
21,
25
Dose
secondary prevention of ischaemic stroke and transient
ischaemic attacks (used alone or with aspirin),
adjunct to oral
anticoagulation for prophylaxis of thromboembolism associated
with prosthetic heart valves, 200 mg twice daily preferably with
food
Note
Dispense in original
container (pack contains a desiccant)
and discard any capsules remaining 6 weeks after opening
With aspirin
For
prescribing information on aspirin,
see under
Aspirin,
p.
152
Asasantin
c
Retard
(Boehringer Ingelheim) A
Capsules
,
red/ivory,
aspirin 25 mg,
dipyridamole
200 mg (m/r),
net price 60-cap pack = £7.79.
Label:
21,
25
Dose
secondary prevention of ischaemic stroke and transient
ischaemic attacks, 1 capsule twice daily
Note
Dispense in original
container (pack contains a desiccant)
and discard any capsules remaining 6 weeks after opening
EPTIFIBATIDE
Indications
prevention of early myocardial infarction
in patients with unstable angina or non-ST-segment-
elevation myocardial infarction and with last episode
of chest pain within 24 hours (use under specialist
supervision)
Cautions
risk of bleeding,
concomitant drugs that
increase risk of bleeding—discontinue immediately if
uncontrolled serious bleeding;
measure baseline
prothrombin time,
activated partial thromboplastin
time,
platelet count,
haemoglobin, haematocrit and
serum creatinine;
monitor haemoglobin,
haematocrit
and platelets within 6 hours after start of treatment
then at least once daily;
discontinue if thrombolytic
therapy,
intra-aortic balloon pump or emergency
cardiac surgery necessary
Contra-indications
abnormal bleeding within 30
days, major surgery or severe trauma within 6 weeks,
stroke within last 30 days or any history of haemor-
rhagic stroke,
intracranial disease (aneurysm, neo-
plasm or arteriovenous malformation),
severe hyper-
tension,
haemorrhagic diathesis,
increased
prothrombin time or INR,
thrombocytopenia
Hepatic impairment
avoid in severe liver disease—
increased risk of bleeding
Renal impairment
reduce infusion to 1 microgram/
kg/minute if eGFR 30–50 mL/minute/1.73 m
2
;
avoid
if eGFR less than 30 mL/minute/1.73 m
2
Pregnancy
manufacturer advises use only if potential
benefit outweighs risk—no information available
Breast-feeding
manufacturer advises avoid—no
information available
Side-effects
bleeding manifestations;
very rarely
anaphylaxis and rash
Dose
. Initially by intravenous injection, 180 micrograms/kg,
then by intravenous infusion,
2 micrograms/kg/min-
ute for up to 72 hours (up to 96 hours if percutaneous
coronary intervention during treatment)
Integrilin
c
(GSK) A
Injection
, eptifibatide 2 mg/mL, net price 10-mL (20-
mg) vial = £13.61
Infusion
,
eptifibatide 750 micrograms/mL,
net price
100-mL (75-mg) vial = £42.79
BNF 61
2.9 Antiplatelet drugs
153
2
Cardiovascular system