Is It Safe to Prescribe PPIs with Clopidogrel?

Because the enzyme that converts clopidogrel to its active form is the same one that metabolizes proton-pump inhibitors (PPIs), concomitant use of both drugs could theoretically decrease the activation of clopidogrel and result in more cardiovascular events. However, despite the U.S. black box warning for concomitant use, the evidence for a clinically significant interaction is weak.

Investigators evaluated the risks for a recurrent cardiovascular event (CVE; myocardial infarction, stroke, or angina) and all-cause mortality in 2285 patients identified from the Swedish Patient Register with a history of gastrointestinal bleeding (GIB) and a first hospitalization for cardiovascular disease between 2006 and 2008. Outcomes within 90 days of disc…