Clopidogrel and possible interaction with Proton Pump Inhibitior (PPI) therapy

There is currently conflicting and inconsistent data regarding the adverse clopidogrel–PPI interaction. With this in mind we need to be vigilant as to the potential weakened benefit of Clopidogrel in the setting of longterm PPI therapy due to the potential interference of the cytochrome P450 enzyme CYP2C19 particularly in patients following a recent coronary artery stent insertion.

Patients who benefit from stomach acid suppression should consider either taking an Histamine Antagonist such as Ranitidine and avoid PPI agents such as Nexium, Losec , Somac, Pariet and Zoton.

Recent data from the FDA, also published in the American Journal of Cardiology, reveal that 1 year data post stent insertion appears to show a near doubling of mortality and myocardial infarction in the PPI group although this has not been supported on recent meta-analysis.