Is Clopidogrel compatible with breastfeeding? Do we have alternatives for Clopidogrel?

Clopidogrel

August 28, 2018 (Low Risk)

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

At the date of last update, we did not find published data on its excretion in breast milk.

Its high percentage of fixation to proteins makes the passage to milk of significant quantities unlikely.
In addition, its low oral bioavailability makes it difficult for infants to pass to plasma from ingested breast milk, except in premature infants and the immediate neonatal period in which there may be greater intestinal permeability.

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

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

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

Alternatives

Very Low Risk

Compatible. Not risky for breastfeeding or infant.

Low Risk

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

High Risk

Poorly safe. Evaluate carefully. Use a safer alternative. Read the Comment.

Very High Risk

Not recommended. Cessation of breastfeeding or alternative.

Synonyms

  • Clopidogrel Besilate, Clopidogrel Besylate
  • Clopidogrel Bisulfate
  • Clopidogrel Hydrochloride

Writings

  • Κλοπιδογρέλη (Greek)
  • كلوبيدوغرال (Arabic)
  • Клопидогрел (Cyrillic)
  • 氯吡格雷 (Chinese)
  • C16 H16 ClNO2 S (Molecular formula)
  • Methyl (2S)-2-(2-chlorophenyl)-2-(4,5,6,7-tetrahydrothieno[3,2-c]pyridin-5-yl)acetate ; Methyl (+)-(S)-α-(o-chlorophenyl)-6,7-dihydrothieno[3,2-c]pyridine-5(4H)-acetate (Chemical name)
  • B01AC04 (ATC Code/s)

Drug trade names

References

  1. Hale TW. Hale's Medications & Mothers' Milk. Springer Publishing Company. 2019
  2. EMA. Clopidogrel (Plavix). Ficha técnica. 2018 Full text (in our servers)
  3. EMA. Clopidogrel (Plavix). Drug Summary. 2018 Full text (in our servers)
  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. 11th edition (acces on line) 2017
  5. 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). 2015Abstract
  6. Rowe H, Baker T, Hale TW. Maternal medication, drug use, and breastfeeding. Pediatr Clin North Am. 2013 Feb;60(1):275-94. 2013Abstract
  7. Yurdakök M. Fetal and neonatal effects of anticoagulants used in pregnancy: a review. Turk J Pediatr. 2012Abstract Full text (link to original source) Full text (in our servers)
  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. 2011Abstract
  9. 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. 2011Abstract
  10. 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. 2008Abstract
  11. Finkelstein Y, Nurmohamed L, Avner M, Benson LN, Koren G. Clopidogrel use in children. J Pediatr. 2005Abstract