Last update: Nov. 4, 2018

B01AC04

Low Risk for breastfeeding


Moderately safe. Probably compatible.
Mild risk possible. Follow up recommended.
Read the Comment.

A platelet antiaggregant indicated in the secondary prevention of thromboembolic events (after myocardial or cerebral infarction), coronary syndrome and atrial fibrillation. Administered orally in a single daily dose (EMA 2018).

Since the last update we have not found published data on its excretion in breastmilk.

Its high percentage of protein binding makes transfer to breastmilk in significant quantities unlikely. In addition, its low oral bioavailability hinders its transfer to the infant’s plasma from breastmilk, except in premature infants and the immediate neonatal period when there may be greater intestinal permeability.

Used with good tolerance in pediatrics even in newborns and infants (Li 2008, Finkelstein 2005)

Several experts consider its use to probably be compatible during breastfeeding, in the event of not being able to find an alternative (Briggs 2017, Hale 2019 p 167, Rowe 2013). The risk can be minimized by waiting, if possible, a minimum of 6 hours after the last dose of the medication before breastfeeding again.

Until there is more published data on this drug in relation to breastfeeding, safer known alternatives may be preferable (Serrano 2015, Bell 2011), especially during the neonatal period and in case of prematurity.

Alternatives

Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Pharmacokinetics

Variable Value Unit
Oral Bioavail. < 50 %
Molecular weight 322 daltons
Protein Binding 98 %
pKa 5,14 -
Tmax 0,75 - 1 hours
T1/2 6 hours

References

  1. EMA. Clopidogrel (Plavix). Ficha técnica. 2018 Full text (in our servers)
  2. EMA. Clopidogrel (Plavix). Drug Summary. 2018 Full text (in our servers)
  3. Serrano Aguayo P, García de Quirós Muñoz JM, Bretón Lesmes I, Cózar León MV. Tratamiento de enfermedades endocrinológicas durante la lactancia. [Endocrinologic diseases management during breastfeeding.] Med Clin (Barc). 2015 Jan 20;144(2):73-9. Abstract
  4. Briggs GG, Freeman RK, Towers CV, Forinash AB. Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk. Wolters Kluwer Health. Tenth edition (acces on line) 2015
  5. Rowe H, Baker T, Hale TW. Maternal medication, drug use, and breastfeeding. Pediatr Clin North Am. 2013 Feb;60(1):275-94. Abstract
  6. Yurdakök M. Fetal and neonatal effects of anticoagulants used in pregnancy: a review. Turk J Pediatr. 2012 Abstract
  7. Bell AD, Roussin A, Cartier R, Chan WS, Douketis JD, Gupta A, Kraw ME, Lindsay TF, Love MP, Pannu N, Rabasa-Lhoret R, Shuaib A, Teal P, Théroux P, Turpie AG, Welsh RC, Tanguay JF. The use of antiplatelet therapy in the outpatient setting: Canadian Cardiovascular Society Guidelines Executive Summary. Can J Cardiol. 2011 Abstract
  8. Bell AD, Roussin A, Cartier R, Chan WS, Douketis JD, Gupta A, Kraw ME, Lindsay TF, Love MP, Pannu N, Rabasa-Lhoret R, Shuaib A, Teal P, Théroux P, Turpie AG, Welsh RC, Tanguay JF; Canadian Cardiovascular Society.. The use of antiplatelet therapy in the outpatient setting: Canadian Cardiovascular Society guidelines. Can J Cardiol. 2011 Abstract
  9. Li JS, Yow E, Berezny KY, Bokesch PM, Takahashi M, Graham TP Jr, Sanders SP, Sidi D, Bonnet D, Ewert P, Jennings LK, Michelson AD; PICOLO Investigators.. Dosing of clopidogrel for platelet inhibition in infants and young children: primary results of the Platelet Inhibition in Children On cLOpidogrel (PICOLO) trial. Circulation. 2008 Abstract
  10. Finkelstein Y, Nurmohamed L, Avner M, Benson LN, Koren G. Clopidogrel use in children. J Pediatr. 2005 Abstract
  11. Hale TW. Hale's Medications & Mothers' Milk. [Internet]. Springer Publishing Company; 1991-. Available from: https://www.halesmeds.com None

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