Last update Feb. 11, 2025

Clopidogrel

Decreased level of risk

New scientific evidences have driven the Apilam staff to update the level of risk associated to this product.
Former level of risk, which was Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary., is now set to Safe product and/or breastfeeding is the best option.

Level of risk reviewed on Feb. 11, 2025

Compatible

Safe product and/or breastfeeding is the best option.

Platelet antiplatelet indicated in the secondary prevention of thromboembolic events (after myocardial or cerebral infarction), coronary syndrome and atrial fibrillation. Oral administration as a single daily dose. (EMA 2018)

It is excreted in breast milk in negligible amounts. (Van Neste 2024)

In addition, its low oral bioavailability hinders passage into infant plasma from ingested breast milk, except in premature infants and immediate neonatal period where there may be increased intestinal permeability.

No adverse effects in infants have been observed with maternal use of clopidogrel during breastfeeding in a small number of post-marketing cases (ScieGen2023). One infant had clinically insignificant plasma levels and two infants aged 7 and 14 months had no problems. (Van Neste 2024)

It has been used with good tolerance in pediatrics even in newborns and infants. (Li 2008, Finkelstein 2005)

The manufacturer and various experts consider the use of this medication during breastfeeding to be probably compatible if an alternative cannot be chosen. (LactMed, ScieGen 2023, Briggs 2017, Hale 2019 p 167, Rowe 2013)

Risk can be minimized by waiting to resume breastfeeding, if possible, a minimum of 6 hours after the last intake of the drug.

Pending further published data on this drug in relation to breastfeeding, safer known alternatives may be preferable (Serrano 2015, Bell 2011), especially during the neonatal period and in case of prematurity.

Alternatives

  • Aspirin (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Clopidogrel is also known as


Clopidogrel in other languages or writings:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. < 50 %
Molecular weight 322 daltons
Protein Binding 98 %
VD 0.56 ± 0.48 l/Kg
pKa 5.14 -
Tmax 1.4 ± 1.1 hours
6 hours
Relative Dose 0.008 %

References

  1. LactMed. Drugs and Lactation Database (LactMed). Internet. Bethesda (MD): National Library of Medicine (US); 2006-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501922/ 2006 - Consulted on April 16, 2024 Full text (link to original source)
  2. Hale TW. Medications & Mothers' Milk. 1991- . Springer Publishing Company. Available from https://www.halesmeds.com Consulted on April 10, 2024 Full text (link to original source)
  3. Van Neste M, Nauwelaerts N, Mols R, Ceulemans M, Passier A, Smits A, Annaert P, Allegaert K. Case series: Clopidogrel exposure in human milk: The UmbrelLACT study - a contribution from the ConcePTION project. Neurotoxicol Teratol 2024;104:107359. (The 4th Joint ENTIS-OTIS conference abstracts September 12th–15th 2024, Nyborg, Denmark) Abstract
  4. ScieGen. Clopidogrel. Drug Summary. 2023 Full text (in our servers)
  5. EMA. Clopidogrel (Plavix). Ficha técnica. 2018 Full text (in our servers)
  6. Serrano Aguayo P, García de Quirós Muñoz JM, Bretón Lesmes I, Cózar León MV. Tratamiento de enfermedades endocrinológicas durante la lactancia. [Endocrinologic diseases management during breastfeeding.] Med Clin (Barc). 2015 Jan 20;144(2):73-9. Abstract
  7. Briggs GG, Freeman RK, Towers CV, Forinash AB. Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk. Wolters Kluwer Health. Tenth edition (acces on line) 2015
  8. Rowe H, Baker T, Hale TW. Maternal medication, drug use, and breastfeeding. Pediatr Clin North Am. 2013 Feb;60(1):275-94. Abstract
  9. Yurdakök M. Fetal and neonatal effects of anticoagulants used in pregnancy: a review. Turk J Pediatr. 2012 Abstract
  10. Bell AD, Roussin A, Cartier R, Chan WS, Douketis JD, Gupta A, Kraw ME, Lindsay TF, Love MP, Pannu N, Rabasa-Lhoret R, Shuaib A, Teal P, Théroux P, Turpie AG, Welsh RC, Tanguay JF. The use of antiplatelet therapy in the outpatient setting: Canadian Cardiovascular Society Guidelines Executive Summary. Can J Cardiol. 2011 Abstract
  11. Bell AD, Roussin A, Cartier R, Chan WS, Douketis JD, Gupta A, Kraw ME, Lindsay TF, Love MP, Pannu N, Rabasa-Lhoret R, Shuaib A, Teal P, Théroux P, Turpie AG, Welsh RC, Tanguay JF; Canadian Cardiovascular Society.. The use of antiplatelet therapy in the outpatient setting: Canadian Cardiovascular Society guidelines. Can J Cardiol. 2011 Abstract
  12. Li JS, Yow E, Berezny KY, Bokesch PM, Takahashi M, Graham TP Jr, Sanders SP, Sidi D, Bonnet D, Ewert P, Jennings LK, Michelson AD; PICOLO Investigators.. Dosing of clopidogrel for platelet inhibition in infants and young children: primary results of the Platelet Inhibition in Children On cLOpidogrel (PICOLO) trial. Circulation. 2008 Abstract
  13. Finkelstein Y, Nurmohamed L, Avner M, Benson LN, Koren G. Clopidogrel use in children. J Pediatr. 2005 Abstract

Total visits

23,059

Help us improve this entry

How to cite this entry

Do you need more information or did not found what you were looking for?

   Write us at elactancia.org@gmail.com

e-lactancia is a resource recommended by La Liga de la Leche, España of Spain

Would you like to recommend the use of e-lactancia? Write to us at corporate mail of APILAM