Plavix side effects, risk and danger, benefit for blood thinning, clopidogrel medication interaction with natural supplements and herbs
June 20 2018 by Ray Sahelian, M.D.

Plavix is a prescription medication marketed by Sanofi-Aventis and Bristol-Myers Squibb. Also known as clopidorgrel, it was launched in 1998. It is currently marketed in over 80 countries. The newer blood thinner Effient is no more effective than the widely used Plavix in preventing death, heart attacks or strokes.

Cardiologists are re-evaluating how they prescribe Plavix, 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 this blood thinner on top of aspirin to try to prevent heart attacks, as many doctors recommend, now have good reason to stop. The Plavix 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.


Dr. Sahelian's opinion
I prefer to stay with aspirin at this time since, in my opinion, Plavix is very expensive and I have not seen enough proof that it is significantly superior to aspirin. Other natural supplements that thin the blood can be used instead as discussed in this blood clots article. Taking Plavix for six months after receiving a stent may be safer and just as effective as two years of treatment.


Boxed warning by FDA
The US Food and Drug Administration has added a Boxed Warning to the label for Plavix to address patients who do not effectively metabolise the drug and therefore may not receive the full benefits of the drug. An available test can identify which patients are “poor metabolisers” and in need of an alternate treatment regimen.


Plavix danger in combination with proton pump inhibitors
Plavix is widely used with proton pump inhibitors, or PPIs, including AstraZeneca's Nexium and Prilosec to cut the risk of gastric problems. In one study, patients with stents who took Plavix with prescription heartburn drugs, including AstraZeneca’s Nexium, were more likely to be hospitalized for a heart attack, stroke, chest pain or a coronary artery bypass operation than those who took Plavix alone.
   Heartburn pills like Nexium and Prilosec stop blood-thinning drugs such as Plavix from working effectively.
   The Food and Drug Administration said in 2009 the stomach-soothing drugs Prilosec and Nexium cut in half the blood-thinning effect of Plavix, known generically as clopidogrel. Regulators said the key ingredient in the heartburn medications blocks an enzyme the body needs to break down Plavix, muting the drug's full effect. Procter & Gamble's Prilosec OTC is available over-the-counter, while AstraZeneca's Nexium is only available with a prescription. The FDA says patients who need to reduce their acid should take drugs from the H-2 blocker family, which include Johnson & Johnson's Mylanta and Boehringer Ingelheim's Zantac. FDA scientists say there is no evidence those drugs interfere with Plavix's blood clotting.


Klin Med (Mosk). 2013. Drug interaction of proton pump inhibitors and clopidogrel taken together. The most common variant of antiplatelet therapy is a combination of ASA and clopidogrel usually referred to as double antiplatelet therapy (DAP). Current consensus recommends intake of proton pump inhibitors (PPI) during DAP to reduce the risk of gastrointestinal complications. However, recent studies showed that this approach is fraught with severe cardiovascular disorders, such as myocardial infarction, stroke, unstable angina, necessity of repeat coronary interventions, and coronary death.

Q. I am taking Plavix and Zantac. Is this dangerous too? I had a heart attack and a stent was put in my artery. I then was put on Aspirin (325 mg), Plavix (75 mg), and Zantac because I have stomach ulcer. I had sever nose bleeding after 2 weeks taking the above medications. My cardiologist reduced aspirin to 81 mg. I don't know how I will tolerate this new regiment.
   A. Nexium and Zantac work in different ways so I don't know if Zantac, an H2 antihistamine, would have a similar interaction with Plavix as would Nexium, a proton pump inhibitor but most likely not.


People who suffer a heart attack nearly double the risk of having another if they are taking the widely used blood thinner Plavix together with a heartburn drug like Prilosec. Plavix, also known as clopidogrel and made by Sanofi-Aventis SA and Bristol-Myers Squibb Co, and aspirin are often used to thin a patient's blood after a heart attack. Doctors also may prescribe a proton pump inhibitor, or PPI, such as AstraZeneca Plc's heartburn drug Prilosec to cut the risk of gastrointestinal bleeding from bloodthinners. A study published in the Journal of the American Medical Association tracked 8,205 U.S. patients who were treated for a heart attack or chest pain known as unstable angina and given Plavix and aspirin. Two-thirds of these patients also took a PPI, primarily Prilosec, and had almost double the risk of having another heart attack or bout of unstable angina compared to those not taking a PPI. Dr. Michael Ho of the Denver VA Medical Center, who led the study, said this drug combination may be responsible for thousands of repeat heart attacks.


Interaction with other medications
Eur J Pharmacol. 2015. Drug-drug interactions between clopidogrel and novel cardiovascular drugs. The combination of aspirin and the thienopyridine clopidogrel is a cornerstone in the prevention of atherothrombotic events. These two agents act in concert to ameliorate the prothrombotic processes stimulated by plaque rupture and vessel injury complicating cardiovascular disease. Guidelines recommend the use of clopidogrel in patients with acute coronary syndromes and in those undergoing percutaneous coronary intervention, and the drug remains the most utilized P2Y12 receptor inhibitor despite the fact that newer antiplatelet agents are now available. In recent years, numerous studies have shown inconsistency in the efficacy of clopidogrel to prevent atherothrombotic events. Studies of platelet function testing have shown variability in the response to clopidogrel. One of the major reason for this phenomenon lies in the interaction between clopidogrel and other drugs that may affect clopidogrel absorption, metabolism, and ultimately its antiplatelet action. Importantly, these drug-drug interactions have prognostic implications, since patients with high on-treatment platelet reactivity associated with reduced clopidogrel metabolism have an increased risk of ischemia. Previous systematic reviews have focused on drug-drug interactions between clopidogrel and specific pharmacologic classes, such as proton pump inhibitors, calcium channel blockers, and statins. However, more recent pieces of scientific evidence show that clopidogrel may also interact with newer drugs that are now available for the treatment of cardiovascular patients.


Q. Do you have any opinion as to whether you can take serrapeptase and Plavix and Lipitor together? I have been told it would not be detrimental.
   A. I am not aware of studies that have looked into the combination of serrapeptase with these medications. Interactions between meds and supplements are not well studied, and much depends on the dosages used and each person's unique response. 

Plavix Prescription

Plavix is one of the world's top-selling drugs. Plavix is prescribed with the intention that it may prevent strokes and heart attacks in patients at risk for these problems. Plavix is in a class of medications called antiplatelet drugs. It apparently works by helping to prevent harmful blood clots.


2007 - A federal judge permanently blocked a Canadian maker of a cheap generic version of blood thinner Plavix from marketing the drug, saying its version infringed on a valid patent for Plavix. U.S. District Judge Sidney H. Stein said Apotex Inc. had failed to prove that the patent was invalid.


Plavix 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 Plavix 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 Plavix for certain patients. The German Institute for Quality and Efficiency in Healthcare (IQWiG) said Plavix 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.

Update and review
2006 - Bristol-Myers Squibb had third-quarter earnings in 2006 plunge as sales of the anti-clotting drug Plavix were hurt by a cheaper generic. New York-based Bristol earned $338 million, or 17 cents per share, from continuing operations, compared with $964 million, or 49 cents per share, in the year-ago quarter. Plavix was hurt by competition from the early introduction of the cheaper generic by privately held Canadian drug maker Apotex Inc. A deal between Bristol-Myers and Apotex to delay the generic for years fell apart and is now under criminal investigation by the U.S. government for possible antitrust violations. The probe has been widened to review whether the deal violated federal securities laws. Plavix, used to prevent blood clots that can trigger heart attacks, was the world's second-biggest medicine, with global annual sales of $6 billion before the generic arrived.

2006 - Plavix 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, Plavix prevents subsequent blockage in the already-damaged heart vessel, which could lead to more heart attacks, stroke - and possibly death. FDA approved Plavix 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.


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 Plavix. 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 Plavix in early 2006, the settlement would have delayed the introduction of that drug until 2011, several months before the expiration of the Plavix patent.


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


Plavix or aspirin?
Is aspirin a cheaper way to prevent a blood clot? Is Plavix being used by doctors mostly because of a major marketing push?

Is there any update info, regarding Plavix and aspirin taking together. I have four stents six months ago, 65, in good health except heart and arteries. I was prescribed Plavix and aspirin. Now stopped taking Plavix. taking aspirin, eating fruits, vegetables, fish, vitamins, and other supplements. At 178, going to 155 is possible, 5'7". Also taking cholesterol and high blood pressure medicine and natural supplements for that. My goal, is to get off prescribed drugs. What do you think my chances are, getting off drugs and, is there possibility to get another 20 years with those stents? Doesn't look like I'll ever get off aspirin, unless something new comes up.
    A. I cannot make predictions regarding the stents since each type is different and the skill of each surgeon who placed it is different. Many people are able to get off their cholesterol and blood pressure medications if they lose weight and take certain supplements.


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

Q. I had a stent inserted in my left subclavian artery due to a small embolism affecting my left baby finger, from an ulcerated plaque. There are no other plaques observed using CT Scan and I am a 61 year old female. I was prescribed plavix 75 mg and aspirin 81 mg per day. The plavix causes shooting head pains, back pain in the area of a scoliosis curve and unbelievably easy bruising. It has also raised my resting heart rate from an average of 63 to 85. I have hyperlipoprotanemia , and I am concerned that the plavix will raise my already increased risk of myocardial infarction. I am also concerned about a spinal haemorrhage due to the severe scoliosis. I would like to take aspirin instead of the plavix since it seems less lethal, and I would like to also take garlic (powder equivalent to fresh) for the cholesterol and as a blood thinner. I have not found anywhere that can suggest dosages of either for my particular circumstances. Can you give a indication of what would be a safe dose?
   A. I am not in a position to offer specific advice. Several factors are involved in such decision making process and it is complicated but you can review the information in the natural blood clot treatment and prevention article, a link is provided near the top of this page.


Q. I had a carotid operation for plaque and have been on Plavix 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 Plavix. It is the responsibility of your physician who prescribes the Plavix to discuss this matter to you in order to avoid excessive bruising or bleeding. There is a possibility that a lower dose of Plavix may be needed if individuals consume certain herbs or more flavonoids. and plant substances.


Q. I have been taking a MSM supplement for many years. However, recently I have been placed on Plavix. Is it safe to take a MSM supplement with Plavix medication?
   A. We have not seen any studies with Plavix in combination with MSM, nor have we seen human studies regarding the role of MSM on blood clotting and platelet function. Caution is advised when supplements and medications are combined since unexpected reactions could occur. Your doctor should be aware of the dietary supplements that you are taking in regards to the additions of prescription medications.


Q.  Two years ago I had an angioplasty procedure and 3 medicated stents inserted. I am currently taking 75 mg of Plavix plus 91 mg aspirin daily to prevent blood clots - have been told clots are more likely to occur with medicated stents. I bruise terribly at the slightest touch and am concerned about Plavix side effects. Also, the price is almost out of my reach and a definite hardship; I am 84, in otherwise fairly good health, am taking Rx for hypertension. What is your opinion of Plavix plus aspirin, vs aspirin therapy alone? I am now cutting my Plavix in half because of the cost. I would appreciate any comments you could make to guide me. Should I look into ordering Plavix from Canada?
   A. It is not possible to predict in any one individual, without a full examination and review of history and blood studies, to know whether Plavix is helpful, whether Plavix is better than aspirin, or whether aspirin alone or natural supplements such as fish oils are a better option. You may wish to review this page on Plavix and come to an agreement with your doctor on the best course of action for your unique situation.

Q. Is there any reason I shouldn't take Wobenzym enzyme supplement with Plavix,or possibly in place of? I presently take 75mg once a day since I had a stroke in April of 2007. I am 68 years old and do not have a weight problem or poor health in general.
   A. The decision to take any supplements along with Plavix or any medication rests with you and your doctor. I have not seen studies regarding the blood thinning potential of Wobenzym and certainly no studies that have combined Wobenzym and Plavix together.


I am taking Plavix because I have 4 small stents in one artery and I gather that there is increasing evidence that this drug, while thinning the blood, also contributes to arteriosclerosis, calcification of the arteries and the aorta. I am also told that vitamin k2 helps with this. Do you have information on the advisabilty of taking vitamin k2, or natto, while taking Plavix?
    No, I don't. Each person and their overall health and medical condition has to be individually and comprehensively evaluated to make the decision on which medications to take, in what dosages, combinations and use with supplements.


I have a quick question about what is your sincere opinion about Plavix? My Mom (53) almost have a thrombosis by blood clots in her right leg, and doctors prescribe for her this drug I am very concern about the side effects of this drug. I think I will prefer warfarin for this one been used for more time. Can you please help me with your advise?
    I can't offer specific advice but hopefully the research on this page can guide you.


My mother went to the hospital with flu like symptoms. They found out she was having a heart attack so they quickly got her ready and put a stint in her heart. They wanted to put her on Plavix so they wrote a script and told her if she stayed on it for the time period her heart would be back to normal. They also told her to take asprin every day. Also put her on Enalapril, carvedilol, Pravastatin. So they prescribed her on Plavix, Asprin, Enalapril, Carvedilol and Pravastatin. They said she had congestive heart failure. We got home and she was doing good sore on her leg from the stint. She had high blood pressure and high cholesterol. We had her meds filled the following day she took the medicine for about 4 days and didn't feel as good. Then she fell in the bath room and was turning purple instantly we tried cpr till the ambulance got here noting worked and she passed away. This all happen in about a 10-15 day period. Heart attack to death. The Dr didn't explain anything about these drugs at all he just came in looked her over and left and he had prescribed them.


I take 75 Plavix and 81 aspirin and am 60 yrs old. I had 2 stents put in 6 yrs ago. I have a sore on my finger and it burst and I can't get it to stop bleeding. I cleaned it and put 2 Band-Aids on it and it soaked through. I would appreciate your advice as to what I could do next to stop it from bleeding.
    This is a personal medical question that requires the attention of your doctor who prescribed the anti clotting medication.


Q. It would be good if, at the end of your post “Plavix side effects….,” you gave, in a few words, what you recommend. Consider my situation: I am literate but untrained in medicine. Therefore, for me to plow through the entire post (about the studies made overthe years, etc.) would be of little help and I would probably get lost anyway. What lay readers need is YOUR recommendation. Maybe your recommendation could begleaned by careful reading of the entire text (then again, maybe not), but itwould be much easier if you ended each of your posts with recommendations. Please email me with your recommendation about Plavix vs. aspirin. I am 70 years old, have never had a heart attack or stroke, easily passed a stress test, and have clear carotids.
   A. I am not able to make specific recommendations because each person's case is very different that another person's case. A doctor has to know the complete history of a patient and results of blood studies and physical exam, dietary history, etc., before making any attempt at specific suggestions on what to take and the dosages.