What are the side effects of Plavix in the elderly?

In this article:

• Why are blood thinners prescribed to seniors?
• What are the side effects of Plavix in the elderly?
• Precautions while taking Plavix

In this article

• Why are blood thinners prescribed to seniors?
• What are the side effects of Plavix in the elderly?
• Precautions while taking Plavix

Plavix (clopidogrel) is an antiplatelet medication that lowers the risk of heart attack and stroke from blood clots in people with conditions that put them at risk. It prevents blood platelets from clumping together, which is the first step in forming a blood clot. According to medical experts and research, possible side effects of Plavix in older adults include bleeding and bruising, which may be serious in the case of an injury or a fall.

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Why are blood thinners prescribed to seniors?

Troy Alexander-El, MD, a board-certified internal medicine physician at Higher Level Healthcare in Portland, Oregon, notes that healthcare providers may prescribe blood thinners, such as Plavix, to older adults with various cardiovascular medical conditions. “Plavix is used after myocardial infarction (heart attack), cerebral vascular accident (stroke), peripheral vascular disease (poor circulation in blood vessels), or after stents are placed in the heart,” she explains. “This medication prevents the formation of clots that may cause heart attacks or strokes.”

Plavix (clopidogrel) is prescribed to older adults with these health conditions because of its efficacy. According to a research study, in patients 80 years or older with primary acute ischemic stroke, using clopidogrel had a lower risk of recurrent stroke and other cardiovascular events in comparison to aspirin, which may also be prescribed after a stroke or heart attack. It also had a lower risk of serious bleeding than aspirin did.

Plavix may also be prescribed off-label to prevent blood clots in people with atrial fibrillation. But usually only if people are unable to take other types of anticoagulants.

What are the side effects of Plavix in the elderly?

Like any medication, Plavix may have side effects that can affect patients of all ages. Because the drug’s mechanism of action interferes with the body’s natural clotting process, it can cause adverse side effects, especially bleeding.

The most common side effects of Plavix include:

• Nosebleeds
• Bruising
• Bleeding that takes longer to stop
• Itching
• Diarrhea
• Stomach pain
• Stomach indigestion

Bleeding is the most common side effect of the prescription drug, especially among older adults. “The elderly are more susceptible to bleeding in the gastrointestinal tract,” says Jennifer Armendariz, RN, FNP-C, AOCNP, a nurse practitioner with a focus on hematology and oncology in El Paso, Texas. “Also, since the elderly are more at risk for falls, bleeding can be more serious in this patient population, especially if there is head trauma.”

In a clinical trial involving 730 patients older than 74 who used Plavix for 12 months, 2.7% of them had major bleeding. The risk of bleeding depends on the condition being treated, other medical conditions, and medications that may interact. In one large review of blood thinners, the risk of serious bleeding ranged from less than 1% with clopidogrel alone to 3.7% when it was combined with aspirin. 

Having co-occurring conditions like diabetes, high blood pressure, and liver or kidney problems may also increase the risk of severe bleeding in older adults who take Plavix.

The potentially serious side effects of clopidogrel include:

• Brown, pink, or red urine
• Tarry, red, or black stools
• Stomach ulcers or severe stomach pain
• Severe anemia
• Severe allergic and skin reactions
• Low white blood cell (leukopenia)
• Coughing up or vomiting blood that looks like coffee grounds or is bloody
• Low platelets
• Jaundice (yellowing of the skin or eyes)
• Muscle or joint pain
• Low blood pressure
• Dizziness
• Loss of taste
• Redness, rash, peeling, and inflammation of the skin
• Trouble breathing or pneumonia
• Serious bleeding or bruising
• Change in consciousness, especially after a fall

If you’re experiencing potentially life-threatening side effects, please dial 911 or have someone take you to the nearest emergency room for immediate medical attention. 

Plavix has a short half-life of about six hours, meaning that most of the antiplatelet drug is cleared from the body within 24 hours. However, it can take days before platelets begin to clot normally again.

“Its blood-thinning effects can last up to a week after stopping the medication,” Dr. Alexander-El says. “That’s why I always remind patients that even routine procedures, like a dental cleaning or tooth extraction, can lead to unexpected bleeding if their provider doesn’t know they’re taking it. Something that feels small can turn into an emergency room visit if the patient isn’t aware of the medication’s lingering effects.”

Precautions while taking Plavix

There are several steps older adults can take to reduce their risk of increased bleeding and other side effects while taking Plavix.

Follow dosage instructions

Be sure to take the drug exactly as your healthcare provider directs, following the dosage instructions on the prescription label.

Be aware of drug interactions or contraindications

Several drugs can interact with Plavix, changing the medication’s effectiveness or causing mild to severe adverse reactions, such as bleeding. “It’s common for patients to take over-the-counter medications, for a headache or knee pain, without realizing the potential interaction,” Dr. Alexander-El says. 

Here are some prescription and over-the-counter (OTC) medications that should be avoided while taking Plavix, or only used under the guidance of a healthcare professional:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): Ibuprofen (Advil, Motrin), naproxen, and aspirin.
• CYP enzyme inhibitors: Fluconazole (Diflucan), ketoconazole (Ketodan), and ritonavir (Norvir).
• Calcium channel blockers: Amlodipine (Norvasc), nifedipine extended-release (Procardia XL), and diltiazem extended-release (Cardizem CD).
• Selective serotonin reuptake inhibitors (SSRIs): Sertraline (Zoloft), paroxetine (Paxil), and fluoxetine (Prozac).
• Selective norepinephrine reuptake inhibitors (SNRIs): Duloxetine (Cymbalta) and venlafaxine (Effexor XR).
• Proton pump inhibitors: Omeprazole (Prilosec) and esomeprazole (Nexium)
• Anticoagulants: Warfarin (Jantoven), rivaroxaban (Xarelto), and apixaban (Eliquis).
• Other antiplatelet drugs: Ticagrelor (Brilinta), acetylsalicylic acid (Asaphen, Entrophen), and prasugrel (Effient).
• Repaglinide 
• Rifampin
• Opioids
• St. John’s wort
• Omega-3 supplements

This isn’t a full list of possible interactions. Tell your healthcare provider about all medications you take, including prescription, OTC, herbal, supplements, and vitamins.

While Plavix can be taken with or without food, one notable exception is grapefruit juice. Grapefruit juice can interact with antiplatelet medications, potentially reducing their effectiveness. One study found that grapefruit juice inhibited the platelet aggregation of 300 milligrams (mg) of clopidogrel by 23%.

A few other things to keep in mind before taking Plavix include:

• Bleeding problems: If you’re actively bleeding or have a bleeding disorder, such as hemophilia or von Willebrand disease, please consult your healthcare provider for medical advice before taking Plavix.
• Other medical conditions: Let your healthcare provider know if you have a history of stomach problems or eye disease, which may put you at increased risk of bleeding.
• Surgery: Since the antiplatelet drug stops your body from making blood clots, it could cause complications during surgery, as you need blood clots to prevent excessive bleeding. Your surgeon may request that you discontinue Plavix five days before treatment.
• Allergic reaction: If you’ve had a previous allergic reaction to Plavix or its ingredients, your healthcare provider will likely not prescribe it. 
• Supplements: Dietary supplements, such as omega-3 fatty acids (sold as fish oil capsules), can inhibit platelet activity. 

Keep a medication list on hand

“I remind my patients to make sure they bring an updated medication list to each appointment,” Armendariz says. “I also encourage my patients to go to the same pharmacy for all of their medication. This makes it easier for the pharmacist to keep track of all

medications the patient is on, and to monitor for possible interactions.”

You can create a handwritten list or use your notes app to keep track of your medications. The U.S. Food and Drug Administration (FDA) offers a free medicine record sheet you can complete on a computer or tablet and print out to share with your healthcare provider and pharmacist.

Notify your healthcare provider before stopping medication

While stopping Plavix immediately doesn’t immediately cause any adverse effects, you should follow your healthcare provider’s instructions on when and how to complete the medication safely. “If a patient is having surgery or dental work, it is very important that the patient notifies their healthcare team so the medication can be stopped prior to the procedure,” Armendariz says.

Make your home safer

Because older adults are more susceptible to falls while taking Plavix, preparing your home before treatment can help keep you safe. “I talk to my patients often about safe proofing their home when it comes to falls,” Armendariz says. “For instance, I advise them to try to get rid of throw rugs because those are a tripping hazard.”

Other tips for safe-proofing your home include:

• Keeping areas with high foot traffic tidy.
• Adding grab bars near toilets and on both the inside and outside of your tub and shower.
• Placing nightlights close to your bed.
• Cleaning up spills as soon as possible.
• Adding non-slip material to indoor and outdoor stairways.
• Keeping electrical cords near walls and away from walking paths.
• Keep a list of emergency numbers nearby or saved in your phone.
• Consider an assistive walking device like a cane or walker if you’re unsteady on your feet.

Avoid or limit alcohol consumption

Both clopidogrel and alcohol can increase your risk of serious bleeding. It’s best to avoid alcoholic beverages entirely or drink in moderation while taking Plavix.