The Medical Letter on Drugs and Therapeutics
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PPI Interactions with Clopidogrel Revisted

Current guidelines recommend use of a proton pump inhibitor (PPI) to decrease the risk of gastrointestinal bleeding in patients taking clopidogrel (Plavix) with aspirin.1 A recent issue of The Medical Letter considered whether omeprazole (Prilosec, and others) or other PPIs could interfere with the antiplatelet effect of clopidogrel.2 The conclusion was that patients taking both drugs should probably continue to do so until more data became available. Several new publications require reconsideration of that recommendation.

MECHANISM OF INTERACTION — Clopidogrel is a prodrug; the cytochrome P450 enzyme CYP2C19 appears to be mainly responsible for its bioactivation. The results of three new studies indicate that patients with common genetic polymorphisms of CYP2C19 resulting in reduced enzyme activity (found in 30% of subjects in one study) were more likely ... more      

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