From the Research
It is recommended to take Plavix (clopidogrel) in the morning and omeprazole in the evening, with at least 12 hours between doses, to minimize potential drug interactions and ensure the effectiveness of Plavix in preventing blood clots. This timing recommendation is based on the fact that omeprazole can reduce the effectiveness of Plavix by interfering with its conversion to its active form in the liver, as both medications work through the CYP2C19 enzyme system 1.
Key Considerations
- The concomitant use of omeprazole and clopidogrel can lead to a significant reduction in the antiplatelet effect of clopidogrel, which may increase the risk of cardiovascular events 2.
- However, a study found that the risk of myocardial infarction was higher in patients taking both clopidogrel and omeprazole, but not mortality or stroke, in a multi-ethnic Asian population 3.
- Another study suggested that administering rabeprazole 4 hours after clopidogrel may minimize potential drug-drug interactions 1.
Alternative Options
- If you need both medications, consider discussing with your doctor about potentially switching to a different acid reducer like famotidine (Pepcid) or pantoprazole, which may have less interaction with Plavix 2, 4.
- Never stop taking either medication without consulting your healthcare provider first, as both serve important purposes—Plavix prevents dangerous blood clots while omeprazole reduces stomach acid to prevent ulcers and bleeding that can sometimes occur with Plavix therapy.
Important Notes
- The risk of a subsequent myocardial infarction was higher in certain ethnic groups, such as Malay and Chinese populations, compared to the Indian population 3.
- It is essential to weigh the benefits and risks of concomitant use of omeprazole and clopidogrel and to monitor patients closely for any adverse effects 5.