plavas-plus
Generic Name
Clopidogrel 75 mg and Aspirin 75 mg (as Acetylsalicylic acid)
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| plavas plus 75 mg tablet | ৳ 12.04 | ৳ 120.40 |
Description
Overview of the medicine
Plavas-Plus 75 mg Tablet is a combination medicine containing Clopidogrel and Aspirin (Acetylsalicylic acid). It is primarily used to prevent blood clots in individuals at risk of cardiovascular events, such as those with a history of heart attack, stroke, or peripheral arterial disease, or in patients with acute coronary syndrome.
Uses & Indications
Dosage
Adults
Usually 1 tablet once daily. For acute coronary syndrome, a loading dose may be prescribed as directed by a physician.
Elderly
No specific dosage adjustment is generally required for elderly patients, but caution is advised due to increased risk of bleeding.
Renal_impairment
No dosage adjustment is generally required for patients with mild to moderate renal impairment. Use with caution in severe renal impairment.
How to Take
Take orally, with or without food. Swallow the tablet whole with a glass of water. Do not crush or chew.
Mechanism of Action
Clopidogrel selectively inhibits the binding of adenosine diphosphate (ADP) to its platelet P2Y12 receptor, thereby inhibiting ADP-mediated platelet activation and aggregation. Aspirin irreversibly inhibits cyclooxygenase (COX) enzymes, which leads to reduced production of thromboxane A2 (TXA2), a potent inducer of platelet aggregation. The combination thus provides dual antiplatelet activity.
Pharmacokinetics
Onset
Clopidogrel: within 2 hours (therapeutic effect 3-7 days). Aspirin: within 1 hour.
Excretion
Clopidogrel: Approximately 50% in urine and 48% in feces. Aspirin: Salicylic acid and its metabolites are primarily excreted by the kidneys.
Half life
Clopidogrel: Parent drug ~8 hours, active metabolite ~30 minutes. Aspirin: 2-3 hours (parent drug), 9-12 hours (salicylate).
Absorption
Clopidogrel is rapidly absorbed from the gastrointestinal tract, but undergoes extensive first-pass metabolism. Aspirin is rapidly and completely absorbed following oral administration.
Metabolism
Clopidogrel is metabolized in the liver by CYP450 enzymes to both active and inactive metabolites. Aspirin is rapidly hydrolyzed to salicylic acid in the GI tract and liver.
Side Effects
Contraindications
- Active pathological bleeding (e.g., peptic ulcer, intracranial hemorrhage)
- Known hypersensitivity to clopidogrel, aspirin, or any component of the formulation
- Severe hepatic impairment
- Severe renal impairment (for aspirin component)
Drug Interactions
Warfarin or other oral anticoagulants
Increased risk of bleeding. Close monitoring is required.
NSAIDs (Nonsteroidal Anti-inflammatory Drugs)
Increased risk of gastrointestinal bleeding. Concomitant use should be avoided or used with caution.
SSRIs (Selective Serotonin Reuptake Inhibitors)
Increased risk of bleeding.
Proton Pump Inhibitors (PPIs) e.g., Omeprazole, Esomeprazole
May reduce the antiplatelet effect of clopidogrel by inhibiting CYP2C19. Avoid concomitant use unless absolutely necessary.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include prolonged bleeding time, gastrointestinal bleeding, confusion, ringing in the ears (tinnitus), and hyperventilation. Management is primarily supportive; administer activated charcoal if ingestion is recent. Blood transfusions or platelet transfusions may be necessary in case of severe bleeding.
Pregnancy & Lactation
Pregnancy Category C for Clopidogrel and D for Aspirin (especially in the third trimester). Aspirin is generally not recommended in the third trimester due to potential fetal harm and increased bleeding risk for mother and fetus. Clopidogrel is excreted in breast milk; avoid breastfeeding or use with caution after consulting a doctor.
Side Effects
Contraindications
- Active pathological bleeding (e.g., peptic ulcer, intracranial hemorrhage)
- Known hypersensitivity to clopidogrel, aspirin, or any component of the formulation
- Severe hepatic impairment
- Severe renal impairment (for aspirin component)
Drug Interactions
Warfarin or other oral anticoagulants
Increased risk of bleeding. Close monitoring is required.
NSAIDs (Nonsteroidal Anti-inflammatory Drugs)
Increased risk of gastrointestinal bleeding. Concomitant use should be avoided or used with caution.
SSRIs (Selective Serotonin Reuptake Inhibitors)
Increased risk of bleeding.
Proton Pump Inhibitors (PPIs) e.g., Omeprazole, Esomeprazole
May reduce the antiplatelet effect of clopidogrel by inhibiting CYP2C19. Avoid concomitant use unless absolutely necessary.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include prolonged bleeding time, gastrointestinal bleeding, confusion, ringing in the ears (tinnitus), and hyperventilation. Management is primarily supportive; administer activated charcoal if ingestion is recent. Blood transfusions or platelet transfusions may be necessary in case of severe bleeding.
Pregnancy & Lactation
Pregnancy Category C for Clopidogrel and D for Aspirin (especially in the third trimester). Aspirin is generally not recommended in the third trimester due to potential fetal harm and increased bleeding risk for mother and fetus. Clopidogrel is excreted in breast milk; avoid breastfeeding or use with caution after consulting a doctor.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
36 months
Availability
Pharmacies, hospitals
Approval Status
Approved by regulatory authorities worldwide (e.g., FDA, EMA, DGDA)
Patent Status
Generic versions available
WHO Essential Medicine
YesClinical Trials
Numerous clinical trials have established the efficacy and safety of clopidogrel and aspirin combination in reducing cardiovascular events in high-risk patients (e.g., CURE, CREDO, PCI-CURE trials).
Lab Monitoring
- Complete Blood Count (CBC) with platelet count (especially if bleeding is suspected).
- Coagulation parameters (PT/INR, aPTT) if there's a bleeding risk or before surgery.
- Liver function tests (LFTs) periodically, especially in patients with pre-existing hepatic impairment.
- Renal function tests (Creatinine, GFR) periodically.
Doctor Notes
- Emphasize patient adherence to therapy and educate about bleeding risks.
- Consider individual patient risk factors for bleeding before initiation and during treatment.
- Review concomitant medications carefully for potential drug interactions, especially PPIs and other anticoagulants/antiplatelets.
Patient Guidelines
- Take the medicine exactly as prescribed by your doctor.
- Do not stop taking the medicine without consulting your doctor, even if you feel well, as it can increase your risk of heart attack or stroke.
- Inform your doctor or dentist about taking this medicine before any surgery or dental procedures.
- Report any unusual bleeding or bruising immediately to your doctor.
Missed Dose Advice
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue with your regular schedule. Do not double the dose.
Driving Precautions
This medicine may cause dizziness in some individuals. If you experience dizziness, avoid driving or operating heavy machinery.
Lifestyle Advice
- Adopt a heart-healthy lifestyle, including a balanced diet low in saturated fats, regular exercise, and maintaining a healthy weight.
- Quit smoking and limit alcohol consumption, as these can increase cardiovascular risk and bleeding risk.
- Manage co-existing conditions like hypertension and diabetes effectively.
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