A study found that tripling the standard dose of clopidogrel was able to overcome genetic resistance to the drug. No major untoward effects were seen during the study.                                                            Team@CMHF

Although most patients respond to the standard clopidogrel dose, a substantial minority have variations in the CYP2C19 gene, which is involved in metabolizing the drug, which reduces the response to treatment. These patients have high residual platelet reactivity and a greater risk of cardiovascular events.

Higher doses of clopidogrel reduced platelet reactivity in patients with genetic resistance to the drug. Although reactivity remained high even at highest dose of 300 mg daily.

The FDA recommended considering alternative treatments in patients categorized as poor metabolizers and also included warning on clopidogrel’s label. Effective treatment to overcome genetic resistance is not yet clear

The researchers suggested that those patients may require one of the newer, more powerful antiplatelets or the addition of cilostazol.

Reference: http://www.medpagetoday.com/MeetingCoverage/AHA/29721