Drug General Information (ID: DDIT1N75WH)
Drug Name			Clopidogrel		Drug Info		Bismuth subsalicylate		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antiplatelet Agents				Antidiarrheals
Structure

Mechanism of Clopidogrel-Bismuth subsalicylate Interaction (Severity Level: Moderate)
Increased risk of bleeding Click to Show/Hide Mechanism Graph
Drug Name		Clopidogrel				Bismuth subsalicylate
Mechanism		Risk of bleeding Antiplatelet				Risk of bleeding Antiplatelet effects
Key Mechanism Factor 1
		Factor Name		Bleeding
		Factor Description		Patients may be at risk for bleeding when the outcome of a disease or disease treatment confounds the standard mechanisms for maintaining hemostasis. Signs or symptoms of abnormal bleeding include: bleeding that takes a long time to stop (including nosebleeds, bleeding gums, bleeding from cuts and abrasions, and menstrual bleeding); severe unexplained bruising, or bruising that becomes larger; blood in the urine or stool, etc.
Mechanism Description		Increased risk of bleeding by the combination of Clopidogrel and Bismuth subsalicylate

Recommended Action
Management		Until further data are available, caution is recommended, especially in patients at risk of bleeding (i.e., GI ulceration), if clopidogrel is coadministered on a long-term basis with drugs that may cause GI lesions. Patients should be advised to promptly report any signs of bleeding to their physician, including pain, red or black stools, or bloody or coffee-ground emesis. Patients should also be counseled to avoid any other over-the-counter salicylate products.

References
1	Klinkhardt U, Kirchmaier CM, Westrup D, Graff J, Mahnel R, Breddin HK, Harder S "Ex vivo-in vitro interaction between aspirin, clopidogrel, and the glycoprotein IIb/IIIa inhibitors abciximab and SR121566A." Clin Pharmacol Ther 67 (2000): 305-13. [PMID: 10741635]
2	Product Information. Plavix (clopidogrel). Bristol-Myers Squibb, Princeton, NJ.