KEY INFORMATION, EXTRA’S
KEY INFORMATION
- Major bleeding risk with concurrent use of anticoagulants/antiplatelets & also if used alongside NSAIDs, SSRIs & SNRIs
- Patients on antidepressants that cause an increase in bleeding risk due to interaction with anti-platelets can be switched to TCAs (e.g., Mirtazapine)
- Avoid PPIs omeprazole/esomeprazole with clopidogrel
EXTRA’S
Aspirin:
- Do not use concurrently with methotrexate.
A low dose of aspirin is okay in pregnancy (100 mg a day) – Avoid long-term use in those who are breastfeeding.
Contraindicated <16 years (Reye’s syndrome).
Adverse effects: asthma, bronchospasms, shortness of breath, Dyspepsia, hypersensitivity reactions.
- Drug interactions that increase bleeding risk: NSAIDs, SSRIs, SNRIs, antiplatelets, anticoagulant
Clopidogrel:
- Avoid PPIs omeprazole/esomeprazole with clopidogrel (use lansoprazole/ pantoprazole instead)
- Avoid in pregnancy and stop breastfeeding if on clopidogrel – adverse effects: GI symptoms, epistaxis, bruising, haematomas – Ticagrelor:
- Additional risks of gouty arthritis and hyperuricaemia – Avoid in pregnancy and breastfeeding – Dipyridamole:
- Used with oral anticoagulation for prosthetic heart valves (warfarin)
- Adverse effects: angina, nausea & vomiting, headaches & dizziness