Heart drug may cause Heart Attack or Bleeding: Clopidogrel
People with heart disease and/or stroke are put on this medicine, but in the majority it leads to heart attack, which it was intended to prevent, or to bleeding emergencies. This test is for you:
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Heart disease or Stroke
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High cholesterol
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Risk of heart attack
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Users of Clopidogrel, Ticagrelor or Prasugrel
The US FDA recommends genetic testing for guiding the appropriate dose of this medicine. If you’re taking expensive drugs that cost Rs 4000-5000 per month, let’s find out if you can take the standard dose and save thousands.
The most common blood thinner has to be given at the right dose for it to be effective and safe. Instead, if you’re taking drugs that are 100-times more expensive, you may be wasting money unnecessarily. The report will predict your risks for emergencies such as heart attack, stroke or internal bleeding when given this medicine, and advice your doctor on the safe dosage or alternative therapy.
On the other hand, those of you that can take this medicine safely may be taking other more expensive drugs. This test will guide you on switching to the cheaper generic medicine and staying healthy both in body and bank account.
FAQ
Is Clopidogrel testing recommended for all users?
Yes. The FDA in USA has recommended pharmacogenetic testing and dosage for clopidogrel prior to use. Clinical Pharmacogenetics Implementation Consortium (CPIC), a professional body of medical geneticists and clinicians, has also recommended pharmacogenetic dosing.
Is testing for CYP2C19 *17 or ultra-rapid metabolism important?
Three variants of CYP2C19 account for >99% of the population genetic variation. Without testing *17, one in 5 patients will be genotyped incorrectly. For instance, *17/*17 will need standard or lower dosage. Without testing for *17, they may be given a much higher dosage which could cause internal bleeding.
Are prasugrel and ticagrelor safer drugs?
There is insufficient clinical evidence to categorically say they are safer. In patients without contraindications and poor/intermediate metabolizers, these drugs may be safer than clopidogrel. However, they are also known to have similar side-effects.
Can I take prasugrel/ticagrelor instead of clopidogrel?
Every drug has its indications and contraindications, and your doctor is in the best position to decide the most appropriate drug for you. Older drugs, such as clopidogrel, may be less expensive and have massive clinical evidence behind them.
Science
Genes tested: CYP2C19*2, CYP2C19*3, CYP2C19*17
Clopidogrel is metabolized in the body to its active form, and this metabolism is controlled by genes. Six out of 10 people carry a mutation either slowing down their metabolism or speeding it up considerably. This results in either inadequate drug or excess of it in blood. Both can be extremely dangerous situations leading to emergency situations such as repeat heart attack, stroke or internal bleeding.
References
Cresci S et al. 2014, Circulation and Cardiovascular Genetics
Horenstein RB et al. 2014, Journal of Clinical Pharmacology
Scott SA et al. 2013, Clinical Pharmacology and Therapeutics
Mao L et al. 2013, Archives of Cardiovascular Diseases
Zabalza M et al. 2012, Heart