📋 Indications & Clinical Dosage
*Prevention of atherothrombotic in combination with aspirin events in patients with acute coronary syndrome:*
Adult: Initially 180 mg for 1 dose, then 90 mg twice daily usually for up to 12 months
*In patients undergoing percutaneous coronary intervention as alternative to clopidogrel:*
Adult: 180 mg, as a single dose
⛔ Contraindications
Moderate to severe hepatic impairment, active bleeding such as peptic ulcer or intracranial haemorrhage
⚠️ Precautions & Warnings
Chronic obstructive pulmonary disease, asthma, bradycardia, discontinue 7 days before elective surgery if antiplatelet effect not desirable, history of hyperuricaemia, patients at increased risk of bleeding from recent trauma, surgery, gastrointestinal bleeding, or coagulation disorders, second- or third-degree AV block, sick sinus syndrome.
🔄 Drug Interactions
Anticoagulants, CYP3A4 inhibitors, CYP3A4 inducers and CYP3A4 substrates, fibrinolytics, anti fibrinolytics, glycoprotein Iib/Iiia inhibitors, thrombolytics, NSAIDs, digoxin, SSRIs, drugs with antiplatelet effects
⚠️ Adverse Reactions / Side Effects
Haemorrhage, bruising, dyspnoea, abdominal pain, diarrhoea, dizziness, dyspepsia, gastritis, headache, nausea, pruritus, rash, vomiting. Rare: Confusion, constipation, hyperuricaemia, paraesthesia, raised serum creatinine, vertigo
🤰 Pregnancy & Lactation Safety
Pregnancy Risk:
Contraindicated in pregnancy.
Lactation / Breastfeeding:
Contraindicated or not recommended
📚 Official Regulatory & Clinical References
- Drug Regulatory Authority of Pakistan (DRAP): Drug Registration, S.R.O. Price Gazettes & National Essential Medicines List (NEML).
- World Health Organization (WHO): Collaborating Centre for Drug Statistics Methodology (ATC/DDD Index).
- Formulary Standards: British National Formulary (BNF) & Pakistan National Formulary (PNF) guidelines.