Clopidogrel activities in patients with renal function impairment

To assess the tolerability, pharmacodynamic effects and pharmacokinetic parameters after repeated doses of clopidogrel (Plavix((R))) in patients with moderate or severe renal failure.

Eight patients with severe renal failure (endogenous creatinine clearance 5 to 15 ml/min) and eight patients with moderate renal impairment (endogenous creatinine clearance 30 to 60 ml/min) were included.

An open, uncontrolled, parallel-group study over 8 days' administration of 75mg once-daily clopidogrel.

Measurement of changes in ADP-induced platelet aggregation and skin bleeding time and of plasma concentrations and urinary excretion of clopidogrel and its main metabolite, SR 26334. Assessment of clinical tolerance and serial haematological and biochemical investigations.

At the end of the dosage period, platelet aggregation was equally inhibited, by about 25%, and bleeding time equally extended, by a factor of about 2, in the two groups. There were no tolerability concerns. Maximum plasma concentration (C(max)) and time to reach C(max ) (t(max)) for clopidogrel were not significantly different between the two groups. SR 26334 excreted into the urine and renal clearance rate were significantly lower in the severely impaired group, while plasma elimination half-lives were not significantly different. C(max) and t(max) did not differ significantly between the two groups, but trough levels and area under the plasma concentration-time curve from zero to 24 hours (AUC(0-24h)) after the last dose were significantly higher in the moderately impaired group.

Clopidogrel 75mg once daily was well tolerated in patients with either moderate or severe renal failure, and provided good inhibition of ADP-induced platelet aggregation without excessive extension of bleeding time. Dose adjustment in such patients does not appear to be required.