Management of clopidogrel hypersensitivity without drug interruption

Initial therapy

Glucocorticoid taper

Example: Methylprednisolone taper^*

Long-acting nonsedating antihistamine

Example: Fexofenadine 180 mg orally each day

Short-acting antihistamine

Example: Diphenhydramine 25 to 50 mg orally before bed

Secondary therapy (for symptom relapse)

Longer course of glucocorticoids

Example: Prednisone 60 mg initially per day, taper by 10 mg every 3 days

Leukotriene inhibitor

Example: Montelukast 10 mg orally each day

Referral to allergist

Protocol used at Thomas Jefferson University Hospital.

* Dosing of glucocorticoids was left to the discretion of the supervising cardiologist. A commonly used regimen was a 6-day tapering course beginning with 24 mg daily (divided into 3 doses) with total daily dose decreasing by 4 mg per day (Medrol Dosepak).

Reproduced from: Campbell KL, Cohn JR, Fischman DL, et al. Management of clopidogrel hypersensitivity without drug interruption. Am J Cardiol 2011; 107:812. Table used with the permission of Elsevier Inc. All rights reserved.

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Management of clopidogrel hypersensitivity without drug interruption