Clinical relevance of clopidogrel-proton pump inhibitors interaction

Core Tip

Core tip: Even though pharmacodynamic studies suggest that omeprazole can attenuate the antiplatelet effect of clopidogrel, this interaction does not appear to translate into increased cardiovascular risk in patients treated with this combination in observational studies. In the only randomized, double-blind, placebo-controlled study that assessed the cardiovascular implications of combining clopidogrel and omeprazole, patients treated with clopidogrel/omeprazole combination had reduced risk for gastrointestinal events and similar risk for cardiovascular events. Other proton pump inhibitors also do not appear to interact with clopidogrel. However, given the limitations of existing studies, the decision to administer proton pump inhibitors to patients treated with clopidogrel should be individualized based on the patient’s bleeding and cardiovascular risk.