Patients Using CYP2C8 Substrates
Patients using CYP2C8 substrates (repaglinide) are at an increased risk while using this medicine. The use of Cpg with repaglinide may increase the level of repaglinide in the body. Patients should take necessary precautions while taking both drugs in combination.
Abnormal Functioning of the Liver
Patients with liver disease are at an increased risk when using this medicine. Take necessary precautions while using Cpg.
Abnormal Functioning of the Kidney
Patients with abnormal functioning of the kidney are at an increased risk when using this medicine. Such patients should take necessary precautions while taking Cpg.
Recurrent Episodes of Stroke
Patients with the continual episodes of
stroke are at an increased risk when using this medicine. Avoid the use of Cpg during the first seven days after an incidence of stroke.
Life-Threatening Blood Disorder
The patients who are using Cpg are at an increased risk of a life-threatening blood disorder (acquired haemophilia). Proper management by specialists or discontinuation of Cpg is required in such patients.
Allergic Reaction among Thienopyridines
Patients who are taking thienopyridines are at an increased risk of allergic reactions. This allergic condition may lead to side effects such as swelling of the lower layer of the skin, low thrombocytes in the blood, skin rash, deficiency of neutrophils in the blood, and life-threatening allergic reaction. Regular monitoring for signs of allergic reaction in patients with a known
allergy to thienopyridines is recommended.
Bleeding Disorder
Patients with
bleeding disorder with clotting in small blood vessels are at an increased risk when using this medicine. This condition may cause low thrombocytes in the blood, deficiency of red blood cells (microangiopathic hemolytic
anemia),
fever, and kidney disorders. This condition requires urgent medical treatment including exchange of blood proteins (
plasmapheresis).
Discontinuation of Cpg
Patients who discontinue Cpg therapy may at an increased risk of heart diseases.
Bleeding Disorders
Patients who are taking thienopyridines are at an increased risk of
bleeding. Thienopyridines may lead to blockage of blood clotting activity for 7-10 days. The process of
platelet transfusion should be followed within 4 hours of starting dose or 2 hours of the maintenance dose.
Patients using CYP2C19 Inhibitors
Patients having poor metabolic activity are at an increased risk when using this medicine. Use of Cpg with omeprazole decreases the blood clotting activity of Cpg in patients with abnormal metabolism. Avoid the use of CYP2C19 inhibitors (omeprazole or esomeprazole) in such patients. Use another
platelet inhibitors (P2Y12) in patients having poor metabolic activity.
Patients with Pathological Conditions
Patients undergoing
surgery or trauma are at an increased risk of
bleeding when using this medicine. Patients should carefully monitor for any signs of bleeding, especially during the first week of treatment and after surgery.
Use of NSAIDs
Patients using
NSAIDs (Non-steroidal anti-inflammatory drugs) with Cpg may increase the risk of
bleeding. Such patients should take necessary precautions while using NSAIDs with Cpg especially during the first weeks of therapy.
Use of Oral Anticoagulants
Patients who are taking Cpg with oral
anticoagulants (warfarin) may increase the risk of
bleeding. The combined use of Cpg with oral anticoagulants is not recommended.
Planning to have Surgery
Such patients are at an increased risk when using this medicine. Discontinue the use of Cpg seven days before undergoing the surgical procedure.