Plavix (Clopidogrel) for Heart Disease

What Members Say Top Tips Side Effects FAQs

Plavix (clopidogrel) is a prescription medication approved by the U.S. Food and Drug Administration (FDA) to lower the risk of heart attack and stroke in adults with acute coronary syndrome (ACS). ACS includes certain types of heart attacks and serious chest pain caused by reduced blood flow to the heart.

What Members Say

MHT logo These insights are based on 468 comments about Plavix from MyHeartDiseaseTeam members. These are the experiences of a small number of people and are not meant to be medical advice.

Benefits:

Plavix helps lower the chance of another heart attack or stroke after stents or other heart events.
It often fits into a once-daily routine.
It can be used with aspirin when prescribed for certain heart conditions.

Considerations:

Bleeding and bruising are common, including nosebleeds, bleeding from cuts, and blood blisters.
Surgery or dental work often requires extra planning with the care team.
Plavix should not be stopped without medical guidance, even if you feel better.

How Plavix Works and How It’s Taken

Plavix is a type of heart disease medication called a P2Y12 platelet inhibitor. It helps prevent platelets, which are blood cells that help form clots, from sticking together. This lowers the chance of blood clots forming and blocking an artery.

Doctors prescribe Plavix when people have:

Acute coronary syndrome — This includes unstable angina, which is chest pain caused by reduced blood flow to the heart, and certain types of heart attacks. For these conditions, Plavix is used with aspirin.
A recent heart attack or stroke — Plavix helps lower the risk of another heart attack or stroke.
Peripheral arterial disease (PAD) — This is a condition in which narrowed arteries reduce blood flow, often to the legs. Plavix helps lower the risk of heart attack and stroke in people with PAD.

Plavix comes as a tablet taken by mouth. The dose depends on the condition being treated.

Typical Dosing for Heart Disease

For people with acute coronary syndrome who need the medicine to start working within hours, the recommended starting dose is 300 milligrams taken once by mouth. This is called a loading dose. After that, the recommended dose is 75 milligrams once daily.

For people who have recently had a heart attack or stroke, or who have peripheral arterial disease, the recommended dose is 75 milligrams once daily, without a loading dose. Starting Plavix without a loading dose for acute coronary syndrome can delay its effect on platelets by several days.

This information is based on prescribing information, but your healthcare provider may tailor your treatment plan. Always follow their guidance.

Top Advice From Members on Plavix

MHT logo The advice below comes from 468 comments by MyHeartDiseaseTeam members. These members’ experiences are not medical advice.

Members who use Plavix often talk about balancing the benefits of treatment with bleeding concerns, side effects, and questions about how long they will need to take it. Many say it helps to stay in close contact with a cardiologist, report side effects early, and ask before making changes around procedures or other medications.

1

Tell your doctor about bleeding and bruising problems.
“The random bleeding from the smallest cut or scratch from Plavix is annoying.”
2

Ask about Plavix before surgery, dental work, or other procedures.
“Tell all of your doctors and your dentist that you are taking Plavix. They should talk to the doctor who prescribed Plavix for you before you have any surgery or invasive procedure.”
3

Check with your doctor about other medicines, including acid reflux drugs.
“Before I take anything, I check with my doctor if it interacts with Plavix. I found out that esomeprazole (Nexium), which I took for acid reflux, should not be taken with Plavix. I contacted my cardiologist, who changed my medicine.”

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Plavix Side Effects

In clinical studies of Plavix, bleeding was the most commonly reported side effect. The rates varied depending on the type of bleeding and whether Plavix was taken with other medicines.

Bruising more easily than usual
Nosebleeds
Hematoma (bleeding under the skin, which can look like a raised bruise)

Serious Side Effects and Warnings

Plavix can cause serious side effects that may require immediate medical attention. These include:

Reduced effectiveness in some people with CYP2C19 gene differences — Plavix may not work as well if the body cannot activate it normally, which can increase the risk of heart attack or stroke.
Serious bleeding — This includes life-threatening or fatal bleeding, such as bleeding in the stomach, intestines, or brain.
Thrombotic thrombocytopenic purpura (TTP) — This rare, serious blood-clotting problem can cause fever, weakness, confusion, kidney problems, and small purple spots on the skin or in the mouth.
Allergic reactions and severe skin reactions — These include angioedema (swelling under the skin) and severe rashes such as Stevens-Johnson syndrome or toxic epidermal necrolysis.

Get medical help right away if you think you are having a serious reaction.

What To Know Before Taking Plavix

Before taking Plavix, tell your doctor if you have had an allergic reaction to clopidogrel, any ingredient in Plavix, or other medicines used to treat your condition.

Tell your doctor about all medicines you take, including prescription drugs, over-the-counter medicines, vitamins, and herbal supplements.

Some medicines may interact with Plavix or increase your risk of bleeding. Tell your doctor if you take:

Aspirin — Taking aspirin with Plavix can increase bleeding risk. Ask your doctor whether you should take both medicines, especially if you have had a stroke.
Nonsteroidal anti-inflammatory drugs (NSAIDs) — These medicines can increase the risk of bleeding in the stomach or intestines.
Warfarin — This blood thinner can increase bleeding risk when taken with Plavix.
Certain antidepressants — Medicines called selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) may increase bleeding risk.
Other antiplatelet medicines — Taking these with Plavix can increase bleeding risk.
Rifampin — This medicine, used to treat certain infections, can increase the effect of Plavix on platelets and may increase bleeding risk.

Also tell your doctor if you take omeprazole or esomeprazole, which are medicines used to reduce stomach acid. These medicines can make Plavix less effective.

Also tell your doctor if you:

Have had stomach or intestinal ulcers.
Have a history of bleeding problems.
Are planning to have surgery or a dental procedure.

Do not take Plavix if you:

Have active bleeding, such as bleeding from a stomach ulcer or bleeding in the brain.
Are allergic to clopidogrel or any ingredient in Plavix.

Do not stop taking Plavix without speaking with your doctor first. Stopping treatment too soon may increase your risk of heart attack or stroke.

If you miss a dose of Plavix, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the next one at your regular time. Do not take two doses at the same time unless your doctor tells you to.

Tell your doctor if you are pregnant or planning to become pregnant. It is not known if Plavix can harm your baby during pregnancy. Talk with your doctor about the risks and benefits of taking Plavix.

Tell your doctor if you are breastfeeding or planning to breastfeed. It is not known if Plavix passes into human breast milk. Talk with your doctor about the risks and benefits of taking Plavix and whether to breastfeed.

Community FAQs

These answers are fact-checked by our editorial staff.

How effective is Plavix for heart disease?

Clinical studies have shown that Plavix can help lower the risk of heart attack and stroke in people with certain heart and blood vessel conditions.

People with acute coronary syndrome without ST-segment elevation — In a study lasting up to one year, 9.3 percent of people taking Plavix with aspirin had a heart-related death, heart attack, or stroke, compared with 11.4 percent of people taking a placebo (an inactive treatment) with aspirin.
People with ST-elevation heart attack — In a study in which treatment lasted up to 28 days or until hospital discharge, 9.2 percent of people taking Plavix with aspirin died, had another heart attack, or had a stroke, compared with 10.1 percent of people taking a placebo with aspirin.
People with a recent heart attack, recent stroke, or peripheral arterial disease — In a study in which people received treatment for an average of 1.6 years, 9.8 percent of people taking Plavix had a stroke caused by a blocked blood vessel, a heart attack, or a death related to blood vessel disease, compared with 10.6 percent of people taking aspirin.

How long does Plavix take to work for heart disease?

Plavix can begin to reduce how strongly platelets stick together within two hours after a single dose taken by mouth. Platelets are blood cells that help form clots.

For people with acute coronary syndrome who need the medicine to work within hours, treatment starts with a single 300-milligram loading dose. This is a higher first dose that helps the medicine start working faster. After that, the recommended dose is 75 milligrams once daily.

Without a loading dose, it can take several more days for Plavix to produce its antiplatelet effect.

Can Plavix be used with other medicines for heart disease?

Yes. Plavix can be used with certain other medicines for heart disease, including aspirin for people with acute coronary syndrome. However, some medicines can increase the risk of bleeding or change how well Plavix works.

Omeprazole and esomeprazole — These medicines reduce stomach acid but can make Plavix less effective. They should be avoided while taking Plavix.
NSAIDs, warfarin, certain antidepressants (SSRIs and SNRIs), and other antiplatelet medicines — These can increase the risk of bleeding when taken with Plavix.
Opioids, such as morphine — These medicines can slow down and reduce how much Plavix is absorbed, which may reduce its effect.
Rifampin — This medicine, used to treat certain infections, can increase Plavix’s effect on platelets and may increase bleeding risk. It should be avoided while taking Plavix.
Repaglinide — This medicine is used to treat diabetes, and Plavix can increase the amount of repaglinide in the blood, which may raise the risk of low blood sugar. Taking these medicines together should be avoided when possible.

Tell your doctor about all medicines you take, including prescription medicines, over-the-counter medicines, vitamins, and herbal supplements. Do not start or stop any medicine without talking to your doctor.