From the Guidelines
Drugs that interfere with Plavix, particularly proton pump inhibitors (PPIs) like omeprazole and esomeprazole, should be avoided or used with caution due to their potential to reduce Plavix's effectiveness in preventing blood clots by inhibiting the CYP2C19 enzyme 1. When considering acid suppression for patients taking Plavix, alternatives like pantoprazole or famotidine are preferred due to their lower interaction potential with Plavix 1. Some key points to consider regarding drug interactions with Plavix include:
- Proton pump inhibitors (PPIs) such as omeprazole and esomeprazole can decrease Plavix's antiplatelet effects 1
- Certain statins, fluconazole, ketoconazole, fluoxetine, and carbamazepine may also interfere with Plavix 1
- St. John's Wort, a common herbal supplement, can reduce Plavix effectiveness 1 It is essential for patients to inform their healthcare provider about all medications they are taking to avoid potentially dangerous interactions that could increase bleeding risk or reduce Plavix's protective effects against heart attack and stroke 1.
From the FDA Drug Label
Proton Pump Inhibitors Advise patients not to take omeprazole or esomeprazole while taking clopidogrel. Dexlansoprazole, lansoprazole, and pantoprazole had less pronounced effects on the antiplatelet activity of clopidogrel than did omeprazole or esomeprazole [see Drug Interactions (7.2)] .
The drugs that interfere with clopidogrel (Plavix) are:
- Omeprazole (Prilosec)
- Esomeprazole (Nexium) These medications may decrease the effectiveness of clopidogrel 2.
From the Research
Drugs that Interfere with Plavix
Plavix, also known as clopidogrel, is an antiplatelet medication used to reduce the risk of heart disease and stroke. However, its effectiveness can be impacted by interactions with other medications.
- The following drugs have been shown to interfere with Plavix:
- Proton pump inhibitors (PPIs) such as omeprazole and esomeprazole, which can inhibit the metabolism of clopidogrel to its active metabolite 3, 4, 5, 6, 7
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, which can block the access of aspirin to platelet cyclo-oxygenase 3
- Statins and calcium channel blockers, which can interact with thienopyridines such as clopidogrel through the CYP3A4/5 pathway 3
- Selective serotonin reuptake inhibitors, which can affect platelet function and increase the risk of bleeding 3
Mechanism of Interaction
The interaction between Plavix and other medications can occur through various mechanisms, including:
- Inhibition of microsomal enzymes that metabolize clopidogrel to its active metabolite, such as CYP2C19 3, 4, 6, 7
- Blockage of access to platelet cyclo-oxygenase, such as with ibuprofen 3
- Interaction with other drugs that affect platelet function, such as selective serotonin reuptake inhibitors 3
Clinical Importance
The clinical importance of these interactions can vary, but they can potentially reduce the effectiveness of Plavix and increase the risk of cardiovascular events or bleeding.