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Omeprazole and clopidogrel: Should clinicians be worried? Full Text
Cleveland Clinic Journal of Medicine, 02/05/2010
Exclusive author commentary
Bhatt DL et al. – The US Food and Drug Administration has issued a warning that omeprazole (Prilosec) reduces the antiplatelet activity of clopidogrel (Plavix) by about 50%...Proton pump inhibitors such as omeprazole reduce the risk of gastrointestinal bleeding in patients on antiplatelet therapy after an acute coronary syndrome or percutaneous coronary intervention. Omeprazole diminishes the antiplatelet activity of clopidogrel by inhibiting the CYP2C19 isoenzyme. Although the interaction between omeprazole and clopidogrel can be demonstrated on platelet function studies, the clinical significance of this interaction is not clear.
Deepak L. Bhatt, MD. MPH (02/06/2010) comments:
While there does appear to be an ex vivo interaction between clopidogrel and omeprazole, there has been no convincing demonstration of a clinically relevant interaction. Physicians will need to use sound judgment to prescribe clopidogrel and omeprazole for patients that truly have an indication for both.
