Clopidogrel and PrandiMet

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Clopidogrel may significantly increase the blood levels and effects of repaglinide, which can lead to severe hypoglycemia, or low blood sugar. Symptoms of hypoglycemia include headache, dizziness, drowsiness, nervousness, weakness, tremor, nausea, hunger, sweating, and palpitation. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

GENERALLY AVOID: Coadministration with clopidogrel may significantly increase the plasma concentrations and hypoglycemic effects of repaglinide. The primary mechanism is thought to be inhibition of the CYP450 2C8-mediated metabolism of repaglinide by one of clopidogrel's glucuronide metabolites. Other, secondary mechanisms may include inhibition of the OATP1B1-mediated hepatic uptake of repaglinide as well as inhibition of intestinal and hepatic metabolism of repaglinide via CYP450 3A4. In nine healthy volunteers, administration of a single 0.25 mg dose of repaglinide on days 1 and 3 of clopidogrel treatment (300 mg on day 1, followed by 75 mg on days 2 and 3) increased mean repaglinide peak plasma concentration (Cmax) by 2.5- and 2.0-fold, respectively, and systemic exposure (AUC) by 5.1- and 3.9-fold, respectively, compared to administration with placebo. Clopidogrel 300 mg and 75 mg also increased the elimination half-life of repaglinide from 1.6 hours to 2.3 hours and 2 hours, respectively. These changes were accompanied by a significant decrease in blood glucose levels. In 3 subjects with the CYP2C8*1/*4 genotype, repaglinide AUC increased up to 8.8- and 7.4-fold during coadministration of clopidogrel 300 mg and 75 mg, respectively.

MANAGEMENT: Concomitant use of repaglinide with clopidogrel should generally be avoided. If coadministration is required, the manufacturers recommend initiating repaglinide at 0.5 mg before each meal and limiting the total daily dose to 4 mg. Increased frequency of glucose monitoring may be necessary. When concomitant clopidogrel is required in a patient stabilized on higher doses of repaglinide, down titrate the repaglinide dosing based on blood glucose levels to not exceed a total daily dose of 4 mg.

Clopidogrel

Generic Name: clopidogrel

Brand name: Plavix

Synonyms: n.a.

What is Clopidogrel?

PrandiMet

Generic Name: metformin / repaglinide

Brand name: PrandiMet

Synonyms: n.a.

What is PrandiMet?