Does Clopidogrel Reduce the Effectiveness of Proton-Pump Inhibitors?

Proton-pump inhibitors (PPIs) are metabolized by the same hepatic enzyme (CYP2C19) that converts clopidogrel to its active form. In vitro studies have suggested a potential reduction in clopidogrel activity in patients taking PPIs. However, recent studies have not demonstrated any convincing clinical interaction between the two agents (JW Gastroenterol Feb 25 2011, JW Gastroenterol Apr 2 2010, and JW Cardiol Oct 6 2010).

To assess whether clopidogrel reduces the effectiveness of the PPI esomeprazole to prevent peptic ulcers and, conversely, whether esomeprazole reduces clopidogrel's antiplatelet activity or its ability to prevent cardiovascular events, investigators in Taiwan conducted a prospective, randomized trial involving 165 patients w…