Clopidogrel Amarox (Clopidogrel)
Antiplatelet medicine to prevent blood clots after heart attack, stroke, and in peripheral arterial disease
Quick Facts About Clopidogrel Amarox
Key Takeaways About Clopidogrel Amarox
- Prevents dangerous blood clots: Clopidogrel irreversibly inhibits the P2Y12 receptor on platelets, reducing the risk of heart attack, stroke, and cardiovascular death in patients with atherosclerotic disease
- Do not stop without medical advice: Abruptly discontinuing clopidogrel — especially after a coronary stent — can lead to stent thrombosis, heart attack, or death. Always consult your doctor before stopping
- Avoid certain proton pump inhibitors: Omeprazole and esomeprazole can reduce clopidogrel's effectiveness by inhibiting the CYP2C19 enzyme needed to activate it. Use pantoprazole or lansoprazole if needed
- Increased bleeding risk: The most important side effect is bleeding. Report any unusual bruising, blood in stools or urine, or prolonged bleeding from cuts to your doctor immediately
- Stop 5–7 days before surgery: Because the antiplatelet effect is irreversible and lasts the lifetime of the platelet, clopidogrel must be stopped well in advance of planned surgical procedures
What Is Clopidogrel Amarox and What Is It Used For?
Clopidogrel Amarox is an antiplatelet medicine containing clopidogrel 75 mg. It is used to prevent atherothrombotic events (heart attacks, strokes, and vascular death) in adults who have had a recent myocardial infarction, recent ischaemic stroke, or established peripheral arterial disease. It is also used with aspirin for acute coronary syndrome.
Clopidogrel is one of the most widely prescribed cardiovascular medicines worldwide. First approved in 1997, it has become a cornerstone of antiplatelet therapy in modern cardiology and vascular medicine. Clopidogrel Amarox is a branded generic formulation that contains clopidogrel hydrogen sulphate equivalent to 75 mg of clopidogrel base, manufactured as a film-coated tablet for oral administration.
The fundamental purpose of clopidogrel is to reduce the likelihood that blood clots will form inside blood vessels, a process known as thrombosis. In patients with atherosclerosis — a condition where fatty deposits (plaques) build up inside artery walls — these plaques can rupture or erode, exposing the underlying tissue to flowing blood. When this happens, platelets rapidly adhere to the damaged area and aggregate together, forming a clot that can partially or completely block the artery. If this occurs in a coronary artery, the result is a heart attack (myocardial infarction). If it occurs in an artery supplying the brain, the result is an ischaemic stroke. Clopidogrel helps prevent this by making platelets less likely to aggregate.
According to the European Society of Cardiology (ESC) and the American Heart Association (AHA), antiplatelet therapy with clopidogrel is recommended as a standard treatment for secondary prevention of atherothrombotic events. The landmark CAPRIE trial (Clopidogrel versus Aspirin in Patients at Risk of Ischaemic Events), published in The Lancet in 1996, demonstrated that clopidogrel 75 mg daily was more effective than aspirin 325 mg daily in reducing the combined risk of ischaemic stroke, myocardial infarction, or vascular death, with a relative risk reduction of 8.7%.
How Clopidogrel Works
Clopidogrel is a prodrug, meaning it must be converted into its active form within the body before it can exert its therapeutic effect. After oral administration, clopidogrel is rapidly absorbed from the gastrointestinal tract and undergoes extensive metabolism in the liver. Approximately 85% of the absorbed dose is hydrolysed by esterases into an inactive carboxylic acid derivative (which has no antiplatelet activity). The remaining 15% is oxidised by hepatic cytochrome P450 (CYP) enzymes — primarily CYP2C19, with contributions from CYP3A4, CYP1A2, and CYP2B6 — through a two-step metabolic process to generate the active thiol metabolite.
This active metabolite works by binding irreversibly to the P2Y12 adenosine diphosphate (ADP) receptor on the surface of platelets. Under normal circumstances, ADP released from damaged blood vessel walls and from activated platelets binds to P2Y12 receptors, triggering a signalling cascade that leads to activation of the glycoprotein IIb/IIIa (GPIIb/IIIa) receptor complex. The GPIIb/IIIa receptor is the major receptor for fibrinogen on the platelet surface, and its activation allows fibrinogen molecules to cross-link adjacent platelets, leading to platelet aggregation and clot formation.
By irreversibly blocking P2Y12, clopidogrel prevents this ADP-mediated activation of GPIIb/IIIa, thereby inhibiting platelet aggregation. Because the binding is irreversible, each platelet that has been exposed to the active metabolite of clopidogrel remains inhibited for its entire remaining lifespan of approximately 7 to 10 days. After discontinuation of clopidogrel, normal platelet function is restored only as new, uninhibited platelets are produced by the bone marrow. It takes approximately five days of 75 mg daily dosing to reach a steady-state level of platelet inhibition (approximately 40–60% inhibition of ADP-induced aggregation).
Approved Indications
Clopidogrel Amarox is approved for use in adults for the following clinical indications:
- Recent myocardial infarction (heart attack): Starting from a few days up to 35 days after the event, to prevent recurrent atherothrombotic events
- Recent ischaemic stroke: Starting from 7 days up to 6 months after the event
- Established peripheral arterial disease (PAD): For ongoing prevention in patients with symptomatic atherosclerotic disease of the peripheral arteries
- Acute coronary syndrome (in combination with aspirin):
- Non-ST-elevation acute coronary syndrome (unstable angina or non-Q-wave myocardial infarction): In combination with aspirin, including patients undergoing percutaneous coronary intervention (PCI) with stent placement
- ST-elevation myocardial infarction (STEMI): In combination with aspirin in medically treated patients eligible for thrombolytic therapy
The combination of clopidogrel and aspirin, known as dual antiplatelet therapy (DAPT), is one of the most widely used treatment strategies in interventional cardiology. The CURE trial (Clopidogrel in Unstable Angina to Prevent Recurrent Events) demonstrated that adding clopidogrel to aspirin in patients with acute coronary syndrome reduced the composite endpoint of cardiovascular death, non-fatal myocardial infarction, and stroke by 20% compared with aspirin alone, albeit with an increased risk of major bleeding.
Because clopidogrel requires activation by the CYP2C19 enzyme, patients who carry genetic variants associated with reduced CYP2C19 function (so-called “poor metabolisers”) may not fully convert clopidogrel to its active form. This can result in reduced antiplatelet effect and potentially higher risk of cardiovascular events. Pharmacogenomic testing is available and may be considered by your doctor, particularly in high-risk clinical situations such as after coronary stent placement.
What Should You Know Before Taking Clopidogrel Amarox?
Before starting Clopidogrel Amarox, tell your doctor about any history of bleeding disorders, recent surgery, liver disease, or planned procedures. Clopidogrel must not be used if you have active pathological bleeding (such as a bleeding peptic ulcer or intracranial haemorrhage) or severe liver impairment. Inform your doctor of all medications you take, especially other blood thinners, PPIs, and NSAIDs.
Clopidogrel is a powerful antiplatelet agent, and its use requires careful consideration of individual risk factors. While it offers significant protection against atherothrombotic events, it also inherently increases the risk of bleeding because it reduces the blood's ability to form clots when they are needed. Your doctor will evaluate your individual benefit-risk profile before prescribing this medication.
Contraindications
You must not take Clopidogrel Amarox if:
- You are allergic (hypersensitive) to clopidogrel or any of the other ingredients in the tablet
- You have a medical condition that is currently causing active bleeding, such as a peptic ulcer or bleeding within the brain (intracranial haemorrhage)
- You have severe liver disease (severe hepatic impairment)
If you think any of these apply to you, or if you are in any doubt, consult your doctor or pharmacist before taking this medicine.
Warnings and Precautions
Talk to your doctor before taking Clopidogrel Amarox if any of the following situations apply to you:
- Risk of bleeding: If you have a condition that increases your risk of bleeding, such as a recent serious injury, recent surgery (including dental surgery), or a planned surgical procedure within the next seven days. Clopidogrel should be stopped 5 to 7 days before elective surgery unless the antiplatelet effect is judged essential
- Recent stroke: If you have had an ischaemic stroke within the past seven days, treatment should not yet be initiated
- Liver problems: If you have moderate liver disease, which may increase your susceptibility to bleeding
- Kidney problems: Limited clinical experience exists in patients with severe renal impairment. Use with caution
- Blood disorders: If you have ever had a blood disorder, particularly low platelet count (thrombocytopenia) or a condition called thrombotic thrombocytopenic purpura (TTP), which causes blood clots to form in small blood vessels throughout the body along with low platelet counts
- Allergic reactions: If you have previously had an allergic reaction to any thienopyridine medicine (such as ticlopidine or prasugrel), there is a possibility of cross-reactivity
In rare cases, clopidogrel has been associated with thrombotic thrombocytopenic purpura (TTP), a serious condition characterised by low platelet counts, haemolytic anaemia, neurological symptoms, kidney dysfunction, and fever. TTP has been reported very rarely, typically within the first two weeks of treatment. It requires urgent medical treatment, usually with plasma exchange. If you experience any unexplained purpura (purple skin spots), fever, confusion, or extreme fatigue shortly after starting clopidogrel, seek immediate medical attention.
Pregnancy and Breastfeeding
If you are pregnant, think you may be pregnant, or are planning to have a baby, ask your doctor or pharmacist for advice before taking Clopidogrel Amarox.
- Pregnancy: Animal studies have not shown direct harmful effects on fertility or the developing foetus, but there are no adequate and well-controlled studies in pregnant women. As a precautionary measure, clopidogrel should preferably not be used during pregnancy unless clearly necessary. Your doctor will assess whether the potential benefit justifies the potential risk
- Breastfeeding: It is not known whether clopidogrel passes into human breast milk. Animal studies have shown that clopidogrel is excreted in breast milk. As a precaution, breastfeeding is not recommended during treatment with clopidogrel. Discuss alternative options with your doctor
Children and Adolescents
Clopidogrel Amarox is not recommended for use in children and adolescents under 18 years of age. Although some clinical studies have evaluated clopidogrel in paediatric populations (particularly in children with congenital heart disease or sickle cell disease), the efficacy in these groups has not been established, and the currently approved formulation is intended for adult use only.
Driving and Operating Machinery
Clopidogrel is unlikely to affect your ability to drive or operate machinery. No studies on the effects on the ability to drive or use machines have been performed, and adverse effects that would impair these abilities have not been commonly reported. However, if you experience any dizziness or lightheadedness, do not drive or operate machinery until the symptoms resolve.
How Does Clopidogrel Amarox Interact with Other Drugs?
Clopidogrel has clinically significant interactions with several common medications. Proton pump inhibitors (particularly omeprazole and esomeprazole) can reduce its effectiveness. Anticoagulants, NSAIDs, and SSRIs increase bleeding risk. Always inform your doctor and pharmacist about all medicines you are taking.
Because clopidogrel requires hepatic metabolism for activation and because its primary effect is to inhibit platelet aggregation, it can interact with a wide range of medications through both pharmacokinetic (how the body processes the drug) and pharmacodynamic (how the drug affects the body) mechanisms. It is critically important that your prescriber is aware of all medications you are taking, including prescription drugs, over-the-counter medicines, and herbal supplements.
Major Interactions
| Interacting Drug/Class | Effect | Recommendation |
|---|---|---|
| Omeprazole / Esomeprazole | Inhibit CYP2C19, reducing formation of active metabolite by 40–50%; decreased antiplatelet effect | Avoid; use pantoprazole or lansoprazole instead |
| Warfarin and oral anticoagulants | Additive bleeding risk through dual anticoagulant/antiplatelet inhibition | Use only when clearly indicated; close monitoring required |
| NSAIDs (ibuprofen, naproxen, diclofenac) | Increased risk of gastrointestinal bleeding due to COX-1 inhibition plus antiplatelet effect | Avoid long-term combination; use gastroprotection if necessary |
| Aspirin (acetylsalicylic acid) | Potentiates antiplatelet activity; increased bleeding risk, particularly GI bleeding | Combination is standard DAPT for ACS/stenting; use lowest effective aspirin dose (75–100 mg) |
| SSRIs / SNRIs (e.g. fluoxetine, sertraline, venlafaxine) | SSRIs inhibit serotonin uptake into platelets, impairing platelet function; additive bleeding risk | Use with caution; monitor for signs of bleeding |
| Repaglinide | Clopidogrel inhibits CYP2C8, increasing repaglinide exposure and risk of hypoglycaemia | Avoid combination; dose adjustment or alternative antidiabetic needed |
Minor Interactions
The following interactions are considered less clinically significant but should still be discussed with your doctor:
- Morphine and other opioids: In patients with acute coronary syndrome, concomitant use of morphine may delay and reduce absorption of oral antiplatelet agents including clopidogrel, potentially reducing its efficacy during the critical early hours of treatment
- Heparin: While commonly used together in acute clinical settings, the combination increases bleeding risk. Clinical studies have not demonstrated a pharmacokinetic interaction, but close monitoring is warranted
- Phenytoin and tolbutamide: These are CYP2C9 substrates. Clopidogrel's active metabolite may inhibit CYP2C9 at high concentrations, but no clinically meaningful interaction has been demonstrated at standard doses
- Ginkgo biloba and other herbal supplements: Herbal products with anticoagulant or antiplatelet properties may increase the risk of bleeding when combined with clopidogrel
The interaction between clopidogrel and certain proton pump inhibitors (PPIs) is one of the most discussed drug interactions in modern cardiology. Omeprazole and esomeprazole are potent inhibitors of CYP2C19, the primary enzyme responsible for converting clopidogrel to its active metabolite. Clinical pharmacology studies have shown that omeprazole reduces the antiplatelet activity of clopidogrel by approximately 40–50%. Regulatory agencies including the FDA and EMA have issued warnings against this combination. If you require acid suppression while taking clopidogrel, pantoprazole is generally considered the safest PPI option because it has the least effect on CYP2C19.
What Is the Correct Dosage of Clopidogrel Amarox?
The standard dose of Clopidogrel Amarox is 75 mg once daily, taken orally with or without food. For acute coronary syndrome, treatment is typically initiated with a loading dose of 300 mg (four tablets at once), followed by 75 mg daily. Treatment duration depends on the clinical indication and is determined by your doctor.
Clopidogrel Amarox should always be taken exactly as your doctor has told you. The dosing regimen varies depending on the clinical indication and the urgency of achieving antiplatelet effect. The 75 mg film-coated tablet can be taken with or without food, and it should be swallowed whole with a glass of water. Try to take it at the same time each day to maintain a consistent level of platelet inhibition.
Adults
Standard Maintenance Dose
The recommended dose is 75 mg (one tablet) once daily. This is the standard dose for all approved indications including secondary prevention after myocardial infarction, after ischaemic stroke, and in established peripheral arterial disease.
| Indication | Loading Dose | Maintenance Dose | Typical Duration |
|---|---|---|---|
| Recent MI / Ischaemic stroke / PAD | None required | 75 mg once daily | Long-term (as directed) |
| Non-ST elevation ACS (with aspirin) | 300 mg single dose | 75 mg once daily (+ aspirin 75–100 mg) | Up to 12 months |
| ST-elevation MI (with aspirin) | 300 mg single dose (age <75) or 75 mg (age ≥75) | 75 mg once daily (+ aspirin) | Up to 4 weeks (or longer per guidelines) |
| After PCI with stent | 300–600 mg single dose | 75 mg once daily (+ aspirin) | 6–12 months (bare-metal or drug-eluting stent) |
Children
Clopidogrel Amarox is not recommended for children and adolescents below 18 years of age. The safety and efficacy of clopidogrel have not been established in the paediatric population for the approved adult indications.
Elderly
No dose adjustment is required for elderly patients. Clinical trials, including the CAPRIE and CURE studies, included substantial numbers of patients aged 65 years and older. No overall differences in safety or efficacy were observed compared with younger patients. However, elderly patients are generally at higher risk of bleeding and may have more comorbidities that require consideration when initiating antiplatelet therapy.
Patients with Renal Impairment
There is limited clinical experience with clopidogrel in patients with severe renal impairment. Therapeutic experience is limited, so clopidogrel should be used with caution in this population. No dose adjustment is required for mild to moderate renal impairment.
Patients with Hepatic Impairment
Therapeutic experience is limited in patients with moderate hepatic disease who may have bleeding diatheses (tendency to bleed). Clopidogrel is contraindicated in severe hepatic impairment. Use with caution in moderate liver disease.
Missed Dose
What to Do If You Miss a Dose
If you forget to take a dose of Clopidogrel Amarox:
- If it has been less than 12 hours since your scheduled dose, take the missed dose as soon as you remember
- If it has been more than 12 hours, skip the missed dose and take the next dose at the usual time
- Do not take a double dose to make up for a forgotten dose
Try to set a daily reminder (such as an alarm) to help you take your medicine at the same time each day. If you frequently forget doses, speak to your pharmacist about strategies to improve adherence.
Overdose
Overdose following clopidogrel administration may lead to prolonged bleeding time and subsequent bleeding complications. There is no specific antidote for clopidogrel overdose. If prompt correction of prolonged bleeding time is required, a platelet transfusion may be appropriate. If you suspect an overdose or accidentally take too many tablets, contact your doctor, go to the nearest emergency department, or call your local poison control centre immediately, even if you feel well.
It is critically important that you do not stop taking clopidogrel without first discussing it with your doctor. Premature discontinuation of clopidogrel — especially within the first few months after coronary stent placement — is associated with a significantly increased risk of stent thrombosis, which can cause a heart attack or be fatal. If you experience side effects that concern you, talk to your doctor about management options rather than stopping the medicine on your own.
What Are the Side Effects of Clopidogrel Amarox?
The most important side effect of clopidogrel is bleeding, which can range from minor bruising and nosebleeds to serious gastrointestinal or intracranial haemorrhage. Other common side effects include diarrhoea, abdominal pain, and indigestion. Rare but serious adverse effects include thrombotic thrombocytopenic purpura (TTP) and severe skin reactions.
Like all medicines, Clopidogrel Amarox can cause side effects, although not everybody gets them. As an antiplatelet agent, the most expected side effect is bleeding, which results directly from the medication's mechanism of action. The risk of bleeding is influenced by several factors, including concomitant use of other blood thinners, aspirin, or NSAIDs, as well as the patient's individual bleeding risk factors. Understanding the potential side effects and when to seek medical attention is important for safe use of this medication.
Contact your doctor or go to the emergency department immediately if you experience any of the following: blood in your vomit; black, tar-like stools (suggesting gastrointestinal bleeding); blood in your urine; bleeding from a cut that does not stop; sudden severe headache, confusion, or weakness on one side of the body (possible intracranial haemorrhage); or unexplained purple spots on the skin accompanied by fever.
Common (affects up to 1 in 10 patients)
- Haematoma: collection of blood under the skin (bruising)
- Epistaxis: nosebleed
- Gastrointestinal bleeding: bleeding from the stomach or intestines, which may appear as blood in stools or black stools
- Diarrhoea
- Abdominal pain
- Dyspepsia: indigestion, heartburn, or stomach discomfort
- Bruising: easy or unusual bruising at injection sites or after minor trauma
Uncommon (affects up to 1 in 100 patients)
- Thrombocytopenia: decreased platelet count
- Leucopenia: decreased white blood cell count
- Eosinophilia: increased eosinophils (a type of white blood cell)
- Headache, dizziness, and paraesthesia (tingling or numbness)
- Intracranial bleeding: bleeding within the brain (a serious complication)
- Gastric ulcer, duodenal ulcer
- Gastritis: inflammation of the stomach lining
- Nausea and vomiting
- Rash, pruritus (itching)
- Haematuria: blood in the urine
- Prolonged bleeding time
Rare (affects up to 1 in 1,000 patients)
- Neutropenia (severe decrease in white blood cells) and agranulocytosis
- Severe thrombocytopenia (platelet count below 30 × 109/L)
- Thrombotic thrombocytopenic purpura (TTP): see warning above
- Retroperitoneal haemorrhage: bleeding behind the abdominal cavity
- Musculoskeletal bleeding: bleeding into joints (haemarthrosis) or muscles
- Eye bleeding: conjunctival, ocular, or retinal haemorrhage
- Bronchospasm: narrowing of the airways
- Interstitial pneumonitis: inflammation of lung tissue
- Hepatitis: liver inflammation
- Acute liver failure
- Severe skin reactions: Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme
- Angioedema: swelling of face, lips, tongue, or throat
- Serum sickness
- Vasculitis: inflammation of blood vessels
Not Known (frequency cannot be estimated from available data)
- Acquired haemophilia A: a very rare condition where the body produces antibodies against its own clotting factors
- Cross-reactive hypersensitivity among thienopyridines (clopidogrel, ticlopidine, prasugrel)
- Insulin autoimmune syndrome: which can cause severe hypoglycaemia, particularly in patients with HLA-DRB1*04:06 genotype (reported predominantly in Japanese patients)
- Drug-induced liver injury (DILI)
- Lichen planus
Bleeding: The Primary Risk
As the primary function of clopidogrel is to inhibit platelet aggregation, bleeding is the most clinically significant side effect. In the CAPRIE trial, the overall incidence of bleeding in patients taking clopidogrel 75 mg daily was approximately 9.3%, compared with 9.3% for aspirin 325 mg daily. The rate of serious gastrointestinal bleeding was significantly lower with clopidogrel (1.99%) compared with aspirin (2.66%). In the CURE trial, which evaluated dual antiplatelet therapy (clopidogrel plus aspirin) versus aspirin alone, major bleeding occurred in 3.7% of patients on dual therapy compared with 2.7% on aspirin alone.
The risk of bleeding is increased in patients who:
- Take concomitant anticoagulants (warfarin, DOACs) or other antiplatelet agents
- Take NSAIDs regularly
- Have a history of peptic ulcer disease or gastrointestinal bleeding
- Are elderly (age ≥75)
- Have low body weight
- Have renal impairment
Managing and Reporting Side Effects
If you experience any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed above. You can also report side effects directly to your national pharmacovigilance authority (such as the Yellow Card Scheme in the United Kingdom, the FDA MedWatch programme in the United States, or the EMA pharmacovigilance system in the European Union). By reporting side effects, you can help provide more information on the safety of this medicine.
How Should You Store Clopidogrel Amarox?
Store Clopidogrel Amarox below 30°C in its original packaging to protect from moisture. Keep out of the sight and reach of children. Do not use after the expiry date printed on the carton and blister pack.
Proper storage of your medication is important to ensure that it remains safe and effective throughout its shelf life. Clopidogrel Amarox film-coated tablets should be stored under the following conditions:
- Temperature: Store below 30°C (86°F). Do not refrigerate or freeze
- Moisture protection: Store in the original blister packaging to protect the tablets from moisture and humidity
- Light protection: Keep in the outer carton when not in use
- Child safety: Keep this medicine out of the sight and reach of children. Store in a secure location
Do not use Clopidogrel Amarox after the expiry date which is stated on the carton and blister pack after “EXP.” The expiry date refers to the last day of that month. Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.
Before taking each dose, visually inspect the tablet. Clopidogrel Amarox 75 mg tablets are film-coated. If you notice any discolouration, crumbling, an unusual odour, or if the blister packaging appears damaged or tampered with, do not take the tablet and consult your pharmacist.
What Does Clopidogrel Amarox Contain?
Each Clopidogrel Amarox film-coated tablet contains 75 mg of clopidogrel (as clopidogrel hydrogen sulphate). The tablets also contain inactive ingredients (excipients) including microcrystalline cellulose, hydroxypropylcellulose, mannitol, crospovidone, citric acid, macrogol 6000, stearic acid, and a film-coating.
The active ingredient in Clopidogrel Amarox is clopidogrel, present as clopidogrel hydrogen sulphate (also known as clopidogrel bisulfate). Each tablet is formulated to deliver 75 mg of clopidogrel base. Clopidogrel hydrogen sulphate is a white to off-white crystalline powder that is practically insoluble in water at neutral pH but freely soluble at pH 1.
Excipients (Inactive Ingredients)
The following excipients are used in the manufacture of Clopidogrel Amarox 75 mg film-coated tablets:
Tablet core:
- Microcrystalline cellulose — a bulking and binding agent
- Hydroxypropylcellulose (low-substituted) — used as a disintegrant and binder
- Mannitol — a sugar alcohol used as a diluent and sweetening agent
- Crospovidone (type A) — a superdisintegrant that helps the tablet break apart for absorption
- Citric acid monohydrate — used to adjust pH and improve stability
- Macrogol 6000 — a polyethylene glycol used as a binder and plasticiser
- Stearic acid — a lubricant that prevents the tablet from sticking to manufacturing equipment
- Hydrogenated castor oil — a lubricant
Film coating:
- Hypromellose (hydroxypropyl methylcellulose) — forms the film coating
- Macrogol 6000 — acts as a plasticiser in the film coat
- Titanium dioxide (E171) — a white colouring agent
- Iron oxide red (E172) — provides the characteristic colour
- Carnauba wax — polishing agent for a smooth finish
Important Composition Notes
Patients with known allergies or intolerances to any of the listed excipients should consult their doctor or pharmacist before taking this medicine. The tablet contains mannitol as an excipient; patients with rare hereditary fructose intolerance should not take this medicine without medical advice. The tablet does not contain lactose, gluten, or sucrose.
Appearance and Packaging
Clopidogrel Amarox 75 mg is a round, biconvex, film-coated tablet. The tablets are available in blister packs of 28, 30, 84, 90, or 100 tablets, although not all pack sizes may be marketed in all countries. Each blister pack is housed in an outer carton along with a patient information leaflet.
Frequently Asked Questions About Clopidogrel Amarox
Clopidogrel Amarox is an antiplatelet medicine used to prevent atherothrombotic events such as heart attacks and strokes. It is prescribed for adults who have had a recent heart attack (myocardial infarction), recent ischaemic stroke, or have established peripheral arterial disease. It is also used in combination with aspirin for acute coronary syndrome, including unstable angina and certain types of heart attack, as well as after coronary stent placement to prevent stent thrombosis.
Clopidogrel is a prodrug that must be converted to its active form by liver enzymes (primarily CYP2C19). The active metabolite irreversibly binds to the P2Y12 ADP receptor on platelets, blocking ADP-mediated platelet activation and aggregation. This prevents platelets from clumping together to form dangerous blood clots in narrowed arteries. The effect lasts for the remaining lifespan of the platelet, approximately 7 to 10 days, which is why it takes several days after stopping the drug for platelet function to fully recover.
The most common side effects of clopidogrel include bleeding (nosebleeds, bruising, gastrointestinal bleeding), diarrhoea, abdominal pain, and indigestion (dyspepsia). Bleeding is the most significant risk because clopidogrel reduces the blood's ability to clot. Most bleeding events are mild to moderate in severity. Seek immediate medical attention for signs of serious bleeding such as blood in vomit or stools, prolonged nosebleeds, blood in urine, or unusual and severe bruising.
Omeprazole and esomeprazole are not recommended with clopidogrel because they inhibit the CYP2C19 enzyme needed to convert clopidogrel into its active form, potentially reducing its antiplatelet effectiveness by 40–50%. Both the FDA and EMA have issued warnings about this interaction. If you need a proton pump inhibitor for acid reflux or stomach protection while taking clopidogrel, your doctor may recommend alternatives such as pantoprazole or lansoprazole, which have less interaction with CYP2C19 and are considered safer options.
If elective surgery is planned and antiplatelet effect is temporarily not desired, clopidogrel should be discontinued at least 5 to 7 days before the procedure. This allows sufficient time for new platelets without clopidogrel inhibition to be produced by the bone marrow. However, never stop clopidogrel without consulting your doctor, as premature discontinuation — especially after coronary stent placement — can increase the risk of stent thrombosis, heart attack, or death. Your doctor will weigh the bleeding risk of surgery against the cardiovascular risk of stopping the drug.
If you miss a dose of Clopidogrel Amarox and it has been less than 12 hours since your usual dosing time, take the missed dose as soon as you remember. If more than 12 hours have passed, skip the missed dose and take your next dose at the regular scheduled time. Do not take a double dose to make up for the one you missed. Setting a daily alarm or using a pill organiser can help prevent missed doses. If you frequently forget doses, speak with your pharmacist about adherence strategies.
References
- European Medicines Agency (EMA). Clopidogrel — Summary of Product Characteristics (Referral). Available at: ema.europa.eu/en/medicines/human/referrals/clopidogrel. Accessed December 2025.
- CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet. 1996;348(9038):1329-1339. doi:10.1016/S0140-6736(96)09457-3
- Yusuf S, Zhao F, Mehta SR, et al. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation (CURE trial). N Engl J Med. 2001;345(7):494-502. doi:10.1056/NEJMoa010746
- Bhatt DL, Cryer BL, Contant CF, et al. Clopidogrel with or without omeprazole in coronary artery disease (COGENT trial). N Engl J Med. 2010;363(20):1909-1917. doi:10.1056/NEJMoa1007964
- Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. 2023;44(38):3720-3826. doi:10.1093/eurheartj/ehad191
- U.S. Food and Drug Administration (FDA). FDA Drug Safety Communication: Reduced effectiveness of Plavix (clopidogrel) in patients who are poor metabolizers of the drug. Updated November 2017.
- Levine GN, Bates ER, Bittl JA, et al. 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy. J Am Coll Cardiol. 2016;68(10):1082-1115.
- World Health Organization (WHO). WHO Model List of Essential Medicines, 23rd List. Geneva: WHO; 2023. Clopidogrel is listed as an essential cardiovascular medicine.
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