Use of NSAIDs
Patients using NSAIDs
(Non-steroidal anti-inflammatory drugs) with Grepid may increase the risk of bleeding
. Such patients should take necessary precautions while using NSAIDs with Grepid especially during the first weeks of therapy.
Use of Oral Anticoagulants
Patients who are taking Grepid with oral anticoagulants
(warfarin) may increase the risk of bleeding
. The combined use of Grepid 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 Grepid seven days before undergoing the surgical procedure.
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.
Life-Threatening Blood Disorder
The patients who are using Grepid are at an increased risk of a life-threatening blood disorder (acquired haemophilia). Proper management by specialists or discontinuation of Grepid is required in such patients.
Recurrent Episodes of Stroke
Patients with the continual episodes of stroke
are at an increased risk when using this medicine. Avoid the use of Grepid during the first seven days after an incidence of stroke.
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 Grepid.
Abnormal Functioning of the Liver
Patients with liver disease are at an increased risk when using this medicine. Take necessary precautions while using Grepid.
Patients Using CYP2C8 Substrates
Patients using CYP2C8 substrates (repaglinide) are at an increased risk while using this medicine. The use of Grepid with repaglinide may increase the level of repaglinide in the body. Patients should take necessary precautions while taking both drugs in combination.
Patients using CYP2C19 Inhibitors
Patients having poor metabolic activity are at an increased risk when using this medicine. Use of Grepid with omeprazole decreases the blood clotting activity of Grepid 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 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.
Discontinuation of Grepid
Patients who discontinue Grepid therapy may at an increased risk of heart diseases.
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
, and kidney disorders. This condition requires urgent medical treatment including exchange of blood proteins (plasmapheresis
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.