Desensitization to clopidogrel: a tailor-made protocol.
Clopidogrel is an antiplatelet drug widely used for treatment and prevention of a variety of cardiovascular diseases. We report a successful desensitization to clopidogrel in a 70-year-old Caucasian man with delayed hypersensitivity (HS) reaction. He developed lip, hand and foot swelling, erythematous papular non-pruritic lesions and arthralgias 2 weeks after starting treatment with clopidogrel 75 mg/d. A 3-hour desensitization protocol was started, achieving a cumulative dose of 154 mg without any reaction, and a daily dose of 75 mg was recommended. On the 4th day, the patient developed skin lesions similar to the previously described. He was treated with topical steroids and oral antihistamines, and the daily dose of clopidogrel was reduced to 20 mg. A new desensitization protocol was established, with a slow dose increment, according to the patient's response. It was only possible to achieve the dose of 75 mg/d after 2 months. Although well tolerated by most patients, HS reactions with clopidogrel may occur and desensitization is rising as a safe alternative in those patients. In delayed reactions with cutaneous lesions, a slower desensitization protocol may be necessary, as in this case.
Drug Allergy Unit, Allergy and Clinical Immunology Department, Centro Hospitalar de Vila Nova de Gaia / Espinho - EPE, Vila Nova de Gaia, Portugal. pccb23@gmail.com.
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P
Barreira
Drug Allergy Unit, Allergy and Clinical Immunology Department, Centro Hospitalar de Vila Nova de Gaia / Espinho - EPE, Vila Nova de Gaia, Portugal.
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S
Cadinha
Drug Allergy Unit, Allergy and Clinical Immunology Department, Centro Hospitalar de Vila Nova de Gaia / Espinho - EPE, Vila Nova de Gaia, Portugal.
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D
Malheiro
Drug Allergy Unit, Allergy and Clinical Immunology Department, Centro Hospitalar de Vila Nova de Gaia / Espinho - EPE, Vila Nova de Gaia, Portugal.
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JP
Moreira da Silva
D000368:Aged; D000077144:Clopidogrel; D003888:Desensitization, Immunologic; D004342:Drug Hypersensitivity / Q000628:therapy*; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives*
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine
Clopidogrel; desensitization; hypersensitivity reaction