Clopidogrel by Ray Sahelian, M.D.

Clopidrogrel, an "anti-platelet" agent, is marketed by Sanofi-Aventis and Bristol-Myers Squibb. Clopidrogrel was launched in 1998. It is currently marketed in over 80 countries.

Cardiologists are re-evaluating how they prescribe Clopidrogrel, a popular heart medication used to prevent blood clots, after a major clinical study found the drug may cause dangerous bleeding in patients who take it along with aspirin to ward off a first heart attack. Some people taking the blood thinner Clopidrogrel on top of aspirin to try to prevent heart attacks, as many doctors recommend, now have good reason to stop. The Clopidrogrel and aspirin combination not only didn’t help most people, but it unexpectedly almost doubled the risk of death, heart attack or stroke for those with no clogged arteries but with worrisome conditions like high blood pressure and high cholesterol.

Clopidrogrel Prescription

Clopidrogrel is one of the world's top-selling drugs. Clopidrogrel is prescribed with the intention that it may prevent strokes and heart attacks in patients at risk for these problems. Clopidrogrel is in a class of medications called antiplatelet drugs. It apparently works by helping to prevent harmful blood clots. For patients with drug-eluting stents who are event-free at six months follow-up (have not had subsequent cardiovascular events or procedures), the extended use of clopidogrel is associated with a reduction in risk for death or heart attack (myocardial infarction) through 24 months after stent implantation. January 10, 2007 issue of JAMA.

Clopidrogrel in Germany

German health insurers, under pressure to cut costs amid reforms, are considering whether to restrict prescription guidelines for Sanofi-Aventis's blood thinner Clopidrogrel in a move that could harm the drug's sales. The Joint Committee (B-GA), the self-regulating body of German health insurers is reviewing a report it had commissioned from an independent research institute which questions the benefits of Clopidrogrel for certain patients. The German Institute for Quality and Efficiency in Healthcare (IQWiG) said Clopidrogrel or Iscover, offered no benefits over aspirin when used alone as a preventative treatment for conditions resulting from arterial diseases. Sanofi-Aventis, the world's third biggest drugmaker, criticised the institute's report.

Clopidrogrel update
September 2006 - Clopidrogrel has been approved for patients who have had a type of heart attack called acute ST-segment elevation myocardial infarction (STEMI), who are not going to have coronary artery repair (angioplasty). A STEMI is a severe heart attack caused by the sudden, total blockage of an artery. In STEMI patients, Clopidrogrel prevents subsequent blockage in the already-damaged heart vessel, which could lead to more heart attacks, stroke - and possibly death. FDA approved Clopidrogrel in November 1997 to decrease platelet function in people who suffer from acute coronary syndrome (ACS). Platelets are the sticky blood cells that help to form a clot and can contribute to blocked coronary arteries. According to the American Heart Association, each year an estimated 500,000 Americans have a STEMI heart attack.

August 2006 - A Bristol-Myers Squibb executive entered a secret side deal with a generic drug maker in hopes of preserving a lucrative monopoly over the anti-clotting drug Clopidrogrel. Those allegations are thought to be the focus of a Department of Justice investigation of Bristol-Myers and the company’s marketing partner for the drug, Sanofi-Aventis. The court filing, made by lawyers for the Canadian generic drug company Apotex, contends that Bristol-Myers made the secret agreement as part of a proposed patent lawsuit settlement with Apotex. The secret deal, Apotex contends, was an effort to evade the scrutiny of the federal and state regulators who were reviewing the settlement. The filing alleges that Dr. Andrew G. Bodnar, a top assistant to Bristol-Myers’s chief executive, Peter R. Dolan, negotiated the secret deal after regulators objected to an earlier version of the patent settlement on the ground that it would stifle competition. Although the Food and Drug Administration approved Apotex’s generic version of Clopidrogrel in early 2006, the settlement would have delayed the introduction of that drug until 2011, several months before the expiration of the Clopidrogrel patent.

August 2006 - Canadian drugmaker Apotex Corp. launched a generic version of Bristol-Myers Squibb Co.'s blockbuster Clopidrogrel anti-clotting medicine, threatening Bristol-Myers' earnings outlook and dividend.

March 2006 - Sanofi-Aventis shares surged after the French drugmaker settled a dispute with generic rival Apotex Inc. that could keep U.S. patent protection on its multibillion-dollar blood thinner Clopidrogrel until 2011.
    

Clopidrogrel or Aspirin?
Clopidrogrel is commonly used to prevent blood clots, but is aspirin a cheaper way to prevent a blood clot? Is Clopidrogrel being used by doctors mostly because of a major marketing push? Clopidrogrel is distributed by Sanofi-Aventis, a French drug manufacturer, and Bristol-Myers Squibb of New York. Clopidrogrel is Sanofi-Aventis's top-selling drug.

Clopidrogrel Side Effects
Serious side effects of Clopidrogrel include bleeding and, rarely, low white blood cell counts or thrombotic thrombocytopenic purpura (low platelet counts with spontaneous bleeding and clotting).

Dr. Sahelian's Opinion
I prefer to stick with aspirin at this time since, in my opinion, Clopidrogrel is very expensive and I have not seen enough proof that it is significantly superior to aspirin.

Clopidrogrel questions
Q. I had a carotid operation for plaque and have been on Clopidrogrel 75 mg since then. i have several diabetic related symptoms for which I take various supplements such as Omega 3, Vitamin E, Garlic, etc. Is there a danger of bruising or bleeding? How do I keep taking the supplements without subjecting myself to excessive bleeding or bruising possibility?
     A. Several supplements decrease coagulation of blood, and so does Clopidrogrel. It is the responsibility of your physician who prescribes the Clopidrogrel to discuss this matter to you in order to avoid excessive bruising or bleeding. There is a possibility that a lower dose of Clopidrogrel may be needed if individuals consume certain herbs or more flavonoids. and plant substances.