NICE supports wider clopidogrel use
GPs will soon be able to prescribe clopidogrel in patients who have had an ischaemic stroke or have peripheral arterial disease or multivascular disease, according to final draft guidance from the National Institute for Health and Clinical Excellence (NICE).
Clopidogrel was previously recommended in such patients for the prevention of vascular events only if they had a contraindication or were intolerant to aspirin - and that approach will still apply for patients who have had a myocardial infarction.
The new guidance also says use of modified-release dipyridamole plus aspirin is an option for patients who have had a transient ischaemic attack, and in patients who have had an ischaemic stroke if clopidogrel is contraindicated or not tolerated. Modified-release dipyridamole alone can be prescribed in patients with ischaemic stroke only if both aspirin and clopidogrel are contraindicated or not tolerated.
Professor Peter Littlejohns, Clinical and Public Health Director at NICE, said the updated recommendation was due to clopidogrel becoming available as a generic preparation and therefore at reduced cost since the previous guidance was issued in 2005. Indeed, NICE advises that patients are initiated on the "least costly licensed preparation" of clopidogrel, which it says is £3.40 for 30 days of treatment on the 75-mg dose, compared with £35.64 for branded clopidogrel.
"Today's draft guidance for clopidogrel and modified release dipyridamole has the potential to have a significant impact on the treatment of many thousands of patients in England and Wales," Professor Littlejohns said.
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By Caroline Price