From the FDA Drug Label
5.3 Discontinuation of Clopidogrel Discontinuation of clopidogrel increases the risk of cardiovascular events. If clopidogrel must be temporarily discontinued (e.g., to treat bleeding or for surgery with a major risk of bleeding), restart it as soon as possible. When possible, interrupt therapy with clopidogrel for five days prior to such surgery. Resume clopidogrel as soon as hemostasis is achieved.
- 4 Thrombotic Thrombocytopenic Purpura (TTP) TTP, sometimes fatal, has been reported following use of clopidogrel, sometimes after a short exposure (<2 weeks).
6 ADVERSE REACTIONS The following serious adverse reactions are discussed below and elsewhere in the labeling: Bleeding [see Warnings and Precautions (5.2)] Thrombotic thrombocytopenic purpura [see Warnings and Precautions (5.4)]
The FDA drug label does not answer the question.
From the Research
It is generally not recommended to use Pepto-Bismol (bismuth subsalicylate) with Plavix (clopidogrel) due to the potential interaction that may increase the risk of clotting events. The primary concern is that Pepto-Bismol contains a salicylate compound similar to aspirin, which can potentially interfere with how Plavix works in your body. Plavix is an antiplatelet medication that helps prevent dangerous blood clots by making your platelets less sticky, and Pepto-Bismol may reduce this important effect.
Potential Risks
- The interaction between Pepto-Bismol and Plavix could potentially increase your risk of the very clotting events that Plavix is prescribed to prevent, such as heart attack or stroke.
- A case study published in 2020 1 highlights the potential adverse effects of over-the-counter medications, including Pepto-Bismol, which can lead to chronic salicylate toxicity.
- Although the evidence regarding the interaction between Plavix and proton pump inhibitors is conflicting, some studies suggest that combining these medications may decrease the effectiveness of Plavix 2, 3, 4.
Alternative Options
- If you need relief from stomach issues while taking Plavix, consider alternatives like Tums (calcium carbonate), Maalox, or Mylanta (aluminum/magnesium hydroxide), which don't contain salicylates and are generally considered safer to use with Plavix.
- Always consult your healthcare provider before combining medications, especially with prescription drugs like Plavix that have specific interactions.
Key Considerations
- The decision to use Pepto-Bismol with Plavix should be guided by a careful assessment of the potential risks and benefits.
- It is essential to prioritize the patient's safety and consider alternative options that minimize the risk of adverse interactions.
- The most recent and highest quality study 4 suggests that aspirin plus proton pump inhibitors may be a better option for patients at high risk of upper gastrointestinal bleeding, but this does not necessarily apply to the use of Pepto-Bismol with Plavix.