Clopidogrel

How does it work?

Plavix tablets contain the active ingredient clopidogrel hydrogen sulphate, which is a type of medicine called an antiplatelet (sometimes referred to as a 'blood-thinning' medicine). It stops blood cells called platelets from clumping together and forming blood clots. Clopidogrel is also available without a brand name, ie as the genericmedicine.

Clopidogrel works by preventing a natural substance called adenosine diphosphate (ADP) from binding to its receptors on platelets. ADP is one of the chemicals in the body that cause platelets to clump together and start the process of blood clotting. As clopidogrel stops ADP from binding to platelets, it reduces the likelihood of clots forming in the blood.

A blood clot that forms inside the blood vessels is known as a thrombosis and can be dangerous, as it can cause a blockage that cuts off the blood supply to an organ. A blockage in the arteries supplying blood to the heart or brain can cause a heart attack or stroke. A blockage in the blood vessels in the extremities, eg legs, may result in gangrene.

Blood clots and blockages mainly result from a build up of atherosclerosis on the inside of blood vessels. Atherosclerosis is a build up of cholesterol and fat cells that narrows the blood vessels and makes their interiors rough and bumpy. This makes it more difficult for blood to flow through the vessels, and increases the likelihood of clots forming in the vessels.

People who have already suffered a heart attack or stroke are at risk of having another because of the atherosclerosis in their arteries. People with unstable angina are also at risk of a heart attack because of the atherosclerosis in their arteries. Similarly, people who have narrowed arteries in their extremities, eg legs (peripheral arterial disease), are also at risk of blood clots. These events are known as atherothrombotic events.

Clopidogrel is used to prevent blood clots forming within blood vessels, and therefore reduce the risk of further atherothrombotic events in these groups of people.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

Pharmacy

Pharmacy is the health profession that links the health sciences with the chemical sciences and it is charged with ensuring the safe and effective use of pharmaceutical drugs. The word derives from theGreek: φάρμακον (pharmakon), meaning "drug" or "medicine"^[1] (the earliest form of the word is the Mycenaean Greek pa-ma-ko, attested in Linear B syllabic script^[2]).

The scope of pharmacy practice includes more traditional roles such as compounding and dispensing medications, and it also includes more modern services related to health care, including clinical services, reviewing medications for safety and efficacy, and providing drug information. Pharmacists, therefore, are the experts on drug therapy and are the primary health professionals who optimize medication use to provide patients with positive health outcomes.

An establishment in which pharmacy (in the first sense) is practiced is called a pharmacy, chemist's or drug store. In the United States and Canada, drug stores commonly sell not only medicines, but also miscellaneous items such as candy (sweets), cosmetics, andmagazines, as well as light refreshments or groceries.

The word pharmacy is derived from its root word pharma which was a term used since the 15th–17th centuries. In addition to pharma responsibilities, the pharma offered general medical advice and a range of services that are now performed solely by other specialist practitioners, such as surgery and midwifery. The pharma (as it was referred to) often operated through a retail shop which, in addition to ingredients for medicines, sold tobacco and patent medicines. The pharmas also used many other herbs not listed.

In its investigation of herbal and chemical ingredients, the work of the pharma may be regarded as a precursor of the modern sciences ofchemistry and pharmacology, prior to the formulation of the scientific method.

Tramadol

BRAND NAME: Ultram, Ultram ER

DRUG CLASS AND MECHANISM: Tramadol is a man-made (synthetic) analgesic (pain reliever). Its exact mechanism of action is unknown but similar morphine. Like morphine, tramadol binds to receptors in the brain (opioid receptors) that are important for transmitting the sensation of pain from throughout the body to. Tramadol, like other narcotics used for the treatment of pain, may be abused. Tramadol is not a nonsteroidal antiinflammatory drug (NSAID) and does not have the increased risk of stomach ulceration and internal bleeding that can occur with NSAIDs.

PRESCRIPTION: Yes

GENERIC AVAILABLE: Yes

PREPARATIONS: Tablets (immediate release): 50 mg. Tablets (extended release): 100, 200, and 300 mg.

STORAGE: Store at room temperature, 15-30 C (59-86 F). Store in a sealed container.

PRESCRIBED FOR: Tramadol is used in the management of moderate to moderately severe pain. Extended release tablets are used for moderate to moderately severe chronic pain in adults who require continuous treatment for an extended period.

DOSING: The recommended dose of tramadol is 50-100 mg (immediate release tablets) every 4-6 hours as needed for pain. The maximum dose is 400 mg/day. To improve tolerance patients should be started at 25 mg/day, and doses may be increased by 25 mg every 3 days to reach 100 mg/day (25 mg 4 times daily). Thereafter, doses can be increased by 50 mg every 3 days to reach 200 mg day (50 mg 4 times daily). Tramadol may be taken with or without food.

Recommended dose for extended release tablets is 100 mg daily which may be increased by 100 mg every 5 days but not to exceed 300 mg /day. Extended release tablets should be swallowed whole and not crushed or chewed.

DRUG INTERACTIONS: Carbamazepine (Tegretol, Tegretol XR , Equetro, Carbatrol) reduces the effect of tramadol by increasing its inactivation in the body. Quinidine (Quinaglute, Quinidex) reduces the inactivation of tramadol, thereby increasing the concentration of tramadol by 50%-60%. Combining tramadol with monoamine oxidase inhibitors (for example, Parnate) or selective serotonin inhibitors ((SSRIs, for example, fluoxetine Prozac]) may result in severe side effects such as seizures or a condition called serotonin syndrome.

Tramadol may increase central nervous system and respiratorydepression when combined with alcohol, anesthetics, narcotics, tranquilizers or sedative hypnotics.

PREGNANCY: The safety of tramadol during pregnancy has not been established.

NURSING MOTHERS: The safety of tramadol in nursing mothers has not been established.

SIDE EFFECTS: Tramadol is generally well tolerated, and side effects are usually transient. Commonly reported side effects include nausea,constipation, dizziness, headache, drowsiness, and vomiting. Less commonly reported side effects include itching, sweating, dry mouth,diarrhea, rash, visual disturbances, and vertigo. Some patients who received tramadol have reported seizures. Abrupt withdrawal of tramadol may result in anxiety, sweating, insomnia, rigors, pain, nausea, diarrhea, tremors, and hallucinations.

Reference: FDA Prescribing Information