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Clopidogrel and NMN or NR: cardiology visit sheet
Take this to the clinician who prescribes your clopidogrel before you start, change or stop an NAD+ precursor. It records why you take clopidogrel, your CYP2C19 result if you have one, the supplement and dose, and any platelet test results, next to the Plavix label facts that matter here.
Your clopidogrel treatment
Why you take clopidogrelcoronary stent, heart attack, stroke, peripheral artery disease
Date of the stent or the event
Daily clopidogrel dose and time of day
CYP2C19 genetic test result, if you have onepoor, intermediate, normal or ultrarapid metabolizer; date of test
Aspirin, another antiplatelet or an anticoagulant
Stomach-acid medicine, by nameomeprazole and esomeprazole are the ones the label singles out
The NAD+ precursor you want to take
Product, and whether it is NMN or NR
Milligrams per day and the time you take it
Date you started, or plan to start
Other supplements taken with it
What the Plavix label says
- Clopidogrel works only after the body converts it to an active form, principally through the liver enzyme CYP2C19.[1]
- Avoid omeprazole and esomeprazole with clopidogrel: both significantly reduce its antiplatelet effect.[1]
- About 2% of White and 4% of Black patients are CYP2C19 poor metabolizers; the share is higher in Asian patients (for example 14% of Chinese patients).[1]
- Tests can identify poor metabolizers, and for them the label says to consider another P2Y12 inhibitor.[1]
- Morphine given with a 600 mg loading dose cut exposure to clopidogrel's active metabolites by 34% in healthy adults.[1]
- Stopping clopidogrel raises the risk of heart attack and other cardiovascular events. Before elective surgery the label says to interrupt it for five days when possible, which is your prescriber's decision.[1]
Platelet function tests, if your cardiologist orders them
The page suggests one test before you start NMN or NR and a repeat 2 to 4 weeks after starting, read against the lab's own cut-off.
| When | Date | Test (VerifyNow PRU or light transmission aggregometry) | Result and lab cut-off | Supplement dose at the time |
|---|---|---|---|---|
| Before starting NMN or NR | ||||
| 2 to 4 weeks after starting | ||||
| After any dose change |
Get help right away
- Bleeding that lasts a long time, pink, red or brown urine, red or black tarry stools, coughing up blood, or vomit that looks like coffee grounds.[1]
- Purple spots on the skin or in the mouth, yellow skin or eyes, unusual paleness or weakness, fever, a fast heartbeat, confusion or speech changes. These can signal TTP, a clotting disorder that can start in less than 2 weeks and needs hospital treatment.[1]
Questions for your cardiologist
- Has my CYP2C19 status been tested, and would the result change your advice about NMN or NR?
- How long ago was my stent placed, and is this a higher-risk time to add any supplement?
- Would a platelet function test before and after starting the supplement be useful for me?
- Is my stomach-acid medicine one the Plavix label says to avoid?
- If NAD+ support matters to me, would ticagrelor or prasugrel be a reasonable alternative to clopidogrel?
- Should I stop NMN or NR before a planned procedure, and when may I restart it?
Sources for the facts on this sheet
- sanofi-aventis U.S. LLC, via DailyMed. Plavix (clopidogrel tablets), for oral use: prescribing information and Medication Guide. Effective 2025-05-30. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=de8b0b67-eb25-4684-83b5-7ad785314227
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.