Clopidogrel

Plavix film-coated tab 75 mg

Dosage
Adult: PO Prophylaxis of thromboembolic events 75 mg once daily. Acute coronary
syndrome

Administration
May be taken with or without food.

Contraindications
Hypersensitivity. Active pathological bleeding. admin within 7 days after MI and
ischaemic stroke, coagulation disorders.

Special Precautions
Patients at risk of increased bleeding from trauma, surgery, or other pathological
conditions; ulcer; renal and hepatic impairment; history of bleeding or haemostatic
disorders. Pregnancy.

Adverse Drug Reactions

Dyspepsia, abdominal pain, nausea, vomiting, flatulence, constipation, gastritis, gastric
and duodenal ulcers. GI upset, diarrhoea, paraesthesia, vertigo, headache, dizziness,
pruritus and rashes.

Drug Interactions
Co-admin with NSAIDs may increase the risk of stomach and intestinal bleeding.

Mechanism of Action
Clopidogrel inhibits adenosine diphosphate (ADP) from binding to its receptor sites on
the platelets and subsequent activation of glycoprotein GP IIb/IIIa complex thus
preventing fibrinogen binding, platelet adhesion and aggregation.
Absorption: Rapidly but incompletely absorbed from the GI tract (oral).
Distribution: Protein-binding: Extensive.
Metabolism: Hepatic: Extensive; converted to inactive carboxylic acid derivative and
thiol derivative (active).
Excretion: Via urine and faeces (as metabolites and unchanged drug).

Enoxaparin
Dosage
Adult: SC Prophylaxis of venous thromboembolism during surgery Low-moderate
risk: 20 mg once daily, start 2 hr before start of procedure. High risk: 40 mg once daily,
start 12 hr before start of procedure.

Contraindications
Hypersensitivity, acute bacterial endocarditis; major bleeding disorder, haemorrhagic
stroke, drug-induced thrombocytopenia.

Special Precautions
Renal or hepatic impairment, history of GI ulceration, uncontrolled hypertension, spinal
or epidural anaesthesia; lactation and pregnancy; elderly. Periodic blood counts, platelet
count and stool occult blood test recommended.

Adverse Drug Reactions

Thrombocytopenia, mild bleeding, inj site irritation, pain and ecchymoses,
hypersensitivity and erythema.

Mechanism of Action
Enoxaparin is a low molecular weight heparin with anticoagulant properties. It acts by
enhancing the inhibition rate of activated clotting factors including thrombin and factor
Xa through its action on antithrombin III.

ASA
Aspirin

Dosage
Adult: PO Prophylaxis of MI 75-325 mg/day. Stent implantation 325 mg 2 hr pre-op,
then 160-325 mg/day. Pain and fever 325-650 mg 4-6 hrly. Max: 4 g/day.

Administration
Should be taken with food.

Contraindications
Hypersensitivity (attacks of asthma, angioedema, urticaria or rhinitis), active peptic
ulceration; pregnancy (3rd trimester), children <12 yr, patients with haemophilia or
haemorrhagic disorders, gout, severe renal or hepatic impairment, lactation.

Adverse Drug Reactions

GI disturbances; prolonged bleeding time, rhinitis, urticaria and epigastric discomfort;
angioedema, salicylism, tinnitus; bronchospasm.
Drug Interactions
Alcohol, corticosteroids, analgin, phenylbutazone and oxyphenbutazone may increase
risk of GI ulceration. Aspirin increases phenytoin levels. May antagonize actions of
uricosurics and spironolactone.

Mechanism of Action
Aspirin is an analgesic, anti-inflammatory and antipyretic. It inhibits cyclooxygenase,
which is responsible for the synthesis of prostaglandin and thromboxane. It also inhibits
platelet aggregation.

Captopril

Dosage
Adult: PO HTN Initial: 12.5 mg twice daily. Maintenance: 25-50 mg twice daily. Max:
50 mg 3 times/day. Heart failure Initial: 6.25-12.5 mg 2-3 times/day. Max: 50 mg 3
times/day.

Administration
Should be taken on an empty stomach. (Take on an empty stomach 1 hr before or 2 hr
after meals.)

Contraindications
Known hypersensitivity to the drug. Bilateral renal artery stenosis, hereditary
angioedema; renal impairment; pregnancy.

Special Precautions
Patients on diuretics or with sodium depletion should discontinue diuretics or increase
sodium intake prior to initiation of therapy. Renal impairment, SLE and other
autoimmune collagen disorders and during concurrent use of immunosuppressant or
leucopenic drugs, monitor WBC count and urinary protein before and during therapy.
Lactation. Porphyria. Severe CHF.

Adverse Drug Reactions

Hypotension, tachycardia, chest pain, palpitations, pruritus, hyperkalaemia. Proteinuria;
angioedema, skin rashes; taste disturbance, nonproductive cough, headache.

Mechanism of Action
Captopril competitively inhibits the conversion of angiotensin I (ATI) to angiotensin II
(ATII), thus resulting in reduced ATII levels and aldosterone secretion. It also increases
plasma renin activity and bradykinin levels. Reduction of ATII leads to decreased sodium
and water retention. By these mechanisms, captopril produces a hypotensive effect and a
beneficial effect in congestive heart failure.
Pravastatin
Dosage
Adult: PO 10-40 mg/day at bedtime, adjust at 4-wkly intervals if needed. Max: 40
mg/day.

Administration
May be taken with or without food.

Contraindications
Hypersensitivity; active liver disease; childn <8 yr. Pregnancy, lactation.

Special Precautions
Severe intercurrent illness increases risk of myopathy, rhabdomyolysis and renal failure;
stop pravastatin during illness. Severe renal impairment, monitor regularly renal function
and creatine kinase. Women of childbearing potential, use adequate contraception.

Adverse Drug Reactions

GI symptoms, headache, insomnia, chest pain, rash, fatigue, dizziness, myalgia,
hypersensitivity, anaphylaxis, angioedema, rhabdomyolysis, renal failure, hepatitis,
alopoecia, paraesthesia, impotence, gynaecomastia.

Mechanism of Action
Pravastatin inhibits HMG-CoA reductase, the enzyme which catalyses the rate-limiting
step in cholesterol biosynthesis. It reduces conc of total cholesterol and LDL (LDL)
cholesterol and triglyceride. It produces an increase in high-density lipoprotein (HDL)
cholesterol and it increases hepatic cholesterol uptake from blood.

Omega-3- acid