Therodel Special Precautions

Due to the risk of bleeding and haematological undesirable effects, blood cell count determination and/or other appropriate testing should be promptly considered whenever clinical symptoms suggestive of bleeding arise during the course of treatment.
As with other antiplatelet agents, Clopidogrel should be used with caution in patients who may be at risk of increased bleeding from trauma, surgery or other pathological conditions and in patients receiving treatment with ASA, nonsteroidal anti-inflammatory drugs, including COX-2 inhibitors, heparin, or glycoprotein IIb/IIIa inhibitors. Patients should be followed carefully for any signs of bleeding including occult bleeding, especially during the first weeks of treatment and/or after invasive cardiac procedures or surgery. The concomitant administration of Clopidogrel with warfarin is not recommended since it may increase the intensity of bleedings.
If a patient is to undergo elective surgery and antiplatelet effect is not necessary, Clopidogrel should be discontinued 7 days prior to surgery. Clopidogrel prolongs bleeding time and should be used with caution in patients who have lesions with a propensity to bleed (particularly gastrointestinal and intraocular).
Patients should be told that it might take longer than usual to stop bleeding when they take Clopidogrel (alone or in combination with ASA), and that they should report any unusual bleeding (site or duration) to their physician. Patients should inform physicians and dentist that they are taking Clopidogrel before any surgery is scheduled and before any new drug is taken. Thrombotic Thrombocytopenic Purpura (TTP) has been reported very rarely following the used of Clopidogrel, sometimes after a short exposure. It is characterized by thrombocytopenia and microangiopathic dysfunction or fever. TTP is a potentially fatal condition requiring prompt treatment including plasmapheresis.
In view of the lack of data, Clopidogrel cannot be recommended in acute ischaemic stroke (less than 7 days).
Therapeutic experience with Clopidogrel is limited in patients with renal impairment. Therefore, Clopidogrel should be used with caution in these patients.
Experience is limited in patients with moderate hepatic disease who have may bleeding diatheses. Clopidogrel should therefore be used with caution in this population.
Patient with rare hereditary problems of galactose intolerance, the Lapp lactase deficiencies or glucose galactose malabsorption should not taken this medicine.