Before taking this medicine
You should not use Greligen if you are allergic to it, or if you have:
any active bleeding; or
a stomach ulcer or bleeding in the brain (such as from a head injury).
Tell your doctor if you have ever had:
an ulcer in your stomach or intestines; or
a bleeding disorder or blood clotting disorder.
Greligen may not work as well if you have certain genetic factors that affect the breakdown of this medicine in your body. Your doctor may perform a blood test to make sure Greligen is right for you.
This medicine is not expected to harm an unborn baby. However, taking Greligen within 1 week before childbirth can cause bleeding in the mother. Tell your doctor if you are pregnant or plan to become pregnant.
You should not breast-feed while using this medicine.
Greligen must be metabolized by CYP450 enzymes to produce the active metabolite that inhibits platelet aggregation. The active metabolite of Greligen selectively inhibits the binding of adenosine diphosphate (ADP) to its platelet P2Y12 receptor and the subsequent ADP-mediated activation of the glycoprotein GPIIb/IIIa complex, thereby inhibiting platelet aggregation. This action is irreversible. Consequently, platelets exposed to Greligen's active metabolite are affected for the remainder of their lifespan (about 7 to 10 days). Platelet aggregation induced by agonists other than ADP is also inhibited by blocking the amplification of platelet activation by released ADP.
Dose-dependent inhibition of platelet aggregation can be seen 2 hours after single oral doses of Plavix. Repeated doses of 75 mg Plavix per day inhibit ADP-induced platelet aggregation on the first day, and inhibition reaches steady state between Day 3 and Day 7. At steady state, the average inhibition level observed with a dose of 75 mg Plavix per day was between 40% and 60%. Platelet aggregation and bleeding time gradually return to baseline values after treatment is discontinued, generally in about 5 days.
Q: I was placed on Plavix following a headache; however, it was not a stroke. I have been using it for a year. I am 67-year-old female. Will I have to always take it?
A: Your question regards Plavix (Greligen) //www.everydayhealth.com/drugs/plavix According to Lexi-Comp, Plavix is used to help prevent the clotting of platelets in your blood. It is usually used in patients that have a history of heart attack or stroke or in patients that have certain disorders of their blood vessels. I would speak to your prescribing physician regarding why you were put on the medication. Patients that are being treated for the above uses, will likely be on the medication for the long duration. Your physician could provide information about your treatment duration. Jen Marsico, RPh
Warnings for other groups
For pregnant women: Studies done in pregnant women taking Greligen have not shown an increased risk of birth defects or miscarriage. Studies of Greligen in pregnant animals also have not shown these risks.
However, there are potential risks to the mother and fetus if a heart attack or stroke occurs during pregnancy. Therefore, the benefit of Greligen in preventing these health events may outweigh any risk of the drug on the pregnancy.
Tell your doctor if you’re pregnant or plan to become pregnant. Greligen should be used during pregnancy only if the potential benefit justifies the potential risk.
For women who are breastfeeding: It isn’t known if Greligen passes into breastmilk. If it does, it may cause serious effects in a child who is breastfed. You and your doctor may need to decide if you’ll take Greligen or breastfeed.
For children: The safety and effectiveness of Greligen hasn’t been established in children younger than 18 years.
Greligen oral tablet is used for long-term treatment. It comes with serious risks if you don’t take it as prescribed.
If you stop taking the drug or don’t take it at all: You increase your risk of heart attack or stroke. These conditions can be fatal.
If you have to temporarily stop taking Greligen, start taking it again as soon as your doctor tells you to. Stopping this drug may increase your risk of serious heart conditions, stroke, or a blood clot in the legs or lungs.
If you miss doses or don’t take the drug on schedule: Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.
If you take too much: You could have dangerous levels of the drug in your body. Symptoms of an overdose of this drug can include bleeding.
If you think you’ve taken too much of this drug, call your doctor or seek guidance from the American Association of Poison Control Centers at 800-222-1222 or through their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.
What to do if you miss a dose: If you miss a dose, take Greligen as soon as you remember. If it’s almost time for your next dose, skip the missed dose. Take only one dose at your regular time. Don’t take two doses of Greligen at the same time unless your doctor tells you to.
How to tell if the drug is working: You should not have a heart attack or stroke.
Keep these considerations in mind if your doctor prescribes Greligen oral tablet for you.
Q: Does Plavix cause dizziness?
A: According to the prescribing information, dizziness was not a reported side effects associated with Plavix (Greligen) treatment. Plavix (Greligen) inhibits the platelets in the blood from clotting and is used to prevent blood clots that can occur after a heart attack, stroke and in patients with certain heart and blood vessel disorders. According to the prescribing information, the most commonly reported side effect associated with Plavix treatment was bleeding. If you experience any signs and symptoms of bleeding, including nosebleeds or other bleeding that will not stop, coughing up blood or vomit that looks like coffee grounds or black, bloody or tarry stools, it is important to contact your healthcare provider immediately. Plavix should be taken with a full glass of water and can be taken without regard to food. If you need dental work or surgery, it is extremely important to inform your doctor that you take Plavix. You may need to stop taking Plavix for at least 5 days prior to surgery or a procedure to avoid bleeding excessively. This should only be done under the supervision of your doctor. You should begin taking Plavix as soon as possible and exactly as directed by your doctor. Beth Isaac, PharmD
Before taking Greligen,
- tell your doctor and pharmacist if you are allergic to Greligen, prasugrel (Effient), ticlopidine (Ticlid), any other medications, or any ingredient in Greligen tablets. Ask your pharmacist or check the Medication Guide for a list of the ingredients.
- tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: anticoagulants ('blood thinners') such as warfarin (Coumadin, Jantoven); aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn); cilostazol; esomeprazole (Nexium); etravirine (Intelence); omeprazole (Prilosec, Prilosec OTC, Zegerid); repaglinide (Prandin, in Prandimet); selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, in Symbyax), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft); and selective serotonin/norepinephrine reuptake inhibitors (SNRIs) such as desvenlafaxine (Khedezla, Pristiq), duloxetine (Cymbalta), sibutramine (no longer available in the U.S.; Meridia), and venlafaxine (Effexor). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor if you have bleeding ulcers (sores in the lining of the stomach or small intestine that are bleeding), bleeding in the brain, or any other condition that causes severe bleeding. Your doctor may tell you that you should not take Greligen.
- tell your doctor if you have recently been injured and if you have or have ever had liver or kidney disease or any condition that may cause bleeding, including stomach problems such as ulcers and certain eye problems.
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking Greligen, call your doctor.
- if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking Greligen. Your doctor may tell you to stop taking Greligen at least 5 days prior to your surgery to avoid excessive bleeding during surgery. Your doctor will tell you when to start taking Greligen again after your surgery.
- you should know that you may bleed more easily or for a longer time than usual while you are taking Greligen. Be careful not to cut or hurt yourself while you are taking Greligen.
4. How and when to take it
Greligen can be taken once a day, at the same time each day.
You can take Greligen with or without food.
Interactions with food and alcohol
There are no known interactions between Greligen and food, although it is a good idea to take Greligen with or after food, to help reduce irritation to the stomach.
It may be safe to drink alcohol with Greligen as long as you:
- check the patient information leaflet that comes with the medicine
- take the correct dose of your medicine
- do not drink more than the maximum recommended daily limits of alcohol
Taking more than the recommended dose increases the risk of irritation to your stomach lining. This risk is increased further if you drink more than the recommended daily limits and may lead to bleeding from the stomach.
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 Greligen group were epistaxis, hematuria, and bruise.
The overall incidence of bleeding is described in Table 1.
Table 1: CURE Incidence of Bleeding Complications (% patients)
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)
Greligen is a prodrug and is metabolized to a pharmacologically active metabolite and inactive metabolites.
In vitro studies have shown that the glucuronide metabolite of Greligen is a strong inhibitor of CYP2C8. Concomitant administration of repaglinide with Plavix increased the systemic exposure to repaglinide (AUC0-∞) by 5.1-fold following the loading dose (300 mg) and by 3.9-fold on day 3 of the maintenance dose (75 mg) of Plavix .
Q: After having heart stents I have been taking Plavix for one year since the last stent was placed. Now I am getting two different opinions about length of taking the drug. One doctor says stop now and one doctor says stay on for life. What should I do?
A: Unfortunately, the medical community is still split on this decision. Plavix is so good at stopping blood clots from forming that many doctors advise patients to continue it for a year or more, as long as patients are not having bleeding problems or any other side effects. It also depends on whether your stent was coated with a medication or if it is a bare stent. People who receive stents that are coated with medication need longer courses of Plavix (Greligen), because it takes much longer for cells to cover their stents. The best thing to do is to have a discussion with your cardiologist in order to decide what your options are.
What else should I know about this drug?
- Greligen is avaialable as tablets: 75 and 300 mg. Tablets should be stored at room temperature, 15 C - 30 C (59 F - 86 F).
- Greligen is available as a generic drug. You need a prescription from your doctor to obtain this medicine.
- Plavix is the brand name available for Greligen in the US.
3. Who can and can't take clop >
Greligen can be taken by adults aged 18 and over.
Greligen isn't suitable for some people. To make sure this medicine is safe for you, tell your doctor if you:
- have had an allergic reaction to Greligen or any other medicines in the past
- have a stomach ulcer or have had stomach ulcers in the past
- have had bleeding in your brain (a brain haemorrhage)
- have a bleeding disorder, such as haemophilia
- have liver or kidney problems
- are trying to get pregnant, already pregnant or breastfeeding
Special cons >
Greligen may not be suitable to take if you have certain health conditions or are taking other medications.
Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately:
- difficulty breathing or swallowing
- swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
- black and tarry stools
- red blood in stools
- bloody vomit
- vomit that looks like coffee grounds
- unusual bleeding or bruising
- pink or brown urine
- slow or difficult speech
- weakness or numbness of an arm or a leg
- changes in vision
- shortness of breath
- fast heartbeat
- pale skin
- purple patches or bleeding under the skin
- yellowing of the skin or eyes
Greligen may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).