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Multiple Oral Dose (Antithrombotic)

A 57 year old Indian man was seen in the cardiac clinic for occasional chest pain on effort. He was diagnosed has having stable ischaemic heart disease with angina pectoris. A decision was made to medicate him with an oral dose (75mg daily) of an anti-thrombotic drug. The patient is relatively well, moderately obese, but has no evidence of liver or renal impairment.

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The anti-thrombotic drug is a prodrug that is activated by cytochrome p450 2C19 to an active metabolite. The active metabolite inhibits the platelet receptor irreversibly, leading to a much longer duration of platelet inhibition than indicated by the very short elimination half-life of the active metabolite.

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