PLAVIX SIDE EFFECTS
- Generic Name: clopidogrel bisulfate
- Brand Name: Plavix
- Drug Class: , Antiplatelet Agents, Hematologic
SIDE EFFECTS
The following serious adverse reactions are discussed below and elsewhere in the labeling:
- Bleeding
- Thrombotic thrombocytopenic purpura
Clinical Trials Experience
Because clinical trials are conducted under widely varying conditions and durations of followup, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.
Plavix has been evaluated for safety in more than 54,000 patients, including over 21,000 patients treated for one year or more. The clinically important adverse reactions observed in trials comparing Plavix plus aspirin to placebo plus aspirin and trials comparing Plavix alone to aspirin alone are discussed below.
Bleeding
CURE
In CURE, Plavix use with aspirin was associated with an increase in major bleeding (primarily gastrointestinal and at puncture sites) compared to placebo with aspirin (see Table 1). The incidence of intracranial hemorrhage (0.1%) and fatal bleeding (0.2%) were the same in both groups. Other bleeding events that were reported more frequently in the clopidogrel group were epistaxis, hematuria, and bruise.
The overall incidence of bleeding is described in Table 1.
Table 1: CURE Incidence of Bleeding Complications (% patients)
| Event | Plavix (+ aspirin) (n=6259) |
Placebo (+ aspirin) (n=6303) |
| Major bleeding* | 3.7 | 2.7 |
| Life-threatening bleeding | 2.2 | 1.8 |
| Fatal | 0.2 | 0.2 |
| 5 g/dL hemoglobin drop | 0.9 | 0.9 |
| Requiring surgical intervention | 0.7 | 0.7 |
| Hemorrhagic strokes | 0.1 | 0.1 |
| Requiring inotropes | 0.5 | 0.5 |
| Requiring transfusion (≥4 units) | 1.2 | 1.0 |
| Other major bleeding | 1.6 | 1.0 |
| Significantly disabling | 0.4 | 0.3 |
| Intraocular bleeding with significant loss of vision | 0.05 | 0.03 |
| Requiring 2-3 units of blood | 1.3 | 0.9 |
| Minor bleeding† | 5.1 | 2.4 |
| * Life-threatening and other major bleeding. † Led to interruption of study medication. |
||
COMMIT
In COMMIT, similar rates of major bleeding were observed in the Plavix and placebo groups, both of which also received aspirin (see Table 2).
Table 2: Incidence of Bleeding Events in COMMIT (% patients)
| Type of Bleeding | Plavix (+ aspirin) (n=22961) |
Placebo (+ aspirin) (n=22891) |
p-value |
| Major* noncerebral or cerebral bleeding | 0.6 | 0.5 | 0.59 |
| Major noncerebral | 0.4 | 0.3 | 0.48 |
| Fatal | 0.2 | 0.2 | 0.90 |
| Hemorrhagic stroke | 0.2 | 0.2 | 0.91 |
| Fatal | 0.2 | 0.2 | 0.81 |
| Other noncerebral bleeding (nonmajor) | 3.6 | 3.1 | 0.005 |
| Any noncerebral bleeding | 3.9 | 3.4 | 0.004 |
| * Major bleeds were cerebral bleeds or noncerebral bleeds thought to have caused death or that required transfusion. | |||
CAPRIE (Plavix vs Aspirin)
In CAPRIE, gastrointestinal hemorrhage occurred at a rate of 2.0% in those taking Plavix versus 2.7% in those taking aspirin; bleeding requiring hospitalization occurred in 0.7% and 1.1%, respectively. The incidence of intracranial hemorrhage was 0.4% for Plavix compared to 0.5% for aspirin.
Other bleeding events that were reported more frequently in the Plavix group were epistaxis and hematoma.
Other Adverse Events
In CURE and CHARISMA, which compared Plavix plus aspirin to aspirin alone, there was no difference in the rate of adverse events (other than bleeding) between Plavix and placebo.
In CAPRIE, which compared Plavix to aspirin, pruritus was more frequently reported in those taking Plavix. No other difference in the rate of adverse events (other than bleeding) was reported.
Postmarketing Experience
The following adverse reactions have been identified during postapproval use of Plavix. Because these reactions are reported voluntarily from a population of an unknown size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
Hemorrhages, including those with fatal outcome, have been reported in patients treated with Plavix.
- Blood and lymphatic system disorders: Agranulocytosis, aplastic anemia/pancytopenia, thrombotic thrombocytopenic purpura (TTP), acquired hemophilia A
- Gastrointestinal disorders: Colitis (including ulcerative or lymphocytic colitis), pancreatitis, stomatitis, gastric/duodenal ulcer, diarrhea
- General disorders and administration site condition: Fever
- Hepatobiliary disorders: Acute liver failure, hepatitis (noninfectious), abnormal liver function test
- Immune system disorders: Hypersensitivity reactions, anaphylactoid reactions, serum sickness, insulin autoimmune syndrome, which can lead to severe hypoglycemia
- Musculoskeletal, connective tissue and bone disorders: Myalgia, arthralgia, arthritis
- Nervous system disorders: Taste disorders, headache, ageusia
- Psychiatric disorders: Confusion, hallucinations
- Respiratory, thoracic and mediastinal disorders: Bronchospasm, interstitial pneumonitis, eosinophilic pneumonia
- Renal and urinary disorders: Increased creatinine levels
- Skin and subcutaneous tissue disorders: Maculopapular, erythematous or exfoliative rash, urticaria, bullous dermatitis, eczema, toxic epidermal necrolysis, Stevens-Johnson syndrome, acute generalized exanthematous pustulosis (AGEP), angioedema, drug-induced hypersensitivity syndrome, drug rash with eosinophilia and systemic symptoms (DRESS), erythema multiforme, lichen planus, generalized pruritus
- Vascular disorders: Vasculitis, hypotension
SRC: NLM .