Clopidogrel an anti-thrombotic drug, usually prescribed to the patients of heart disease; after cleaning the coronary artery of a atherosclerotic plaque and/or placing a stent inside the artery to keep that open.
Clopidogrel interacts with the proton pump inhibitors (PPIs); and more so with omeprazole. Clopidogrel has the adverse effect of causing bleeding from stomach. Concomitant administration of omeprazole decreases the activity of clopidogrel; which may result in more cardiovascular events and hospital re-admissions. That is because both compete for same enzyme in the liver, PPIs may interfere in metabolism of clopidogrel to its active form.
Many times PPIs are prescribed to help arresting bleeding episodes in stomach and co-prescribed with clopidogrel or clopidogrel and aspirin combination. The bleeding tendency is increased in case a patient is already on steroids, analgesics, blood thinning agent like aspirin or warfarin. PPIs are very much helpful in these cases.
It has been agreed upon by the top researchers in the field to individualize such combination rather than a blanket rule. They recommend PPIs other than omeprazole in case the patient has a pre-existing disease like peptic ulcer; disease requiring long term steroid use, analgesics or warfarin. Sometimes in place of PPIs H2 receptor antagonists like ranitidine or famotidine can be used; though these are less powerful than PPIs in arresting bleeding or ulceration.
The preventive role of PPIs in stomach bleeding from clopidogrel has not been clearly substantiated.
So, those patient taking PPIs to ward off the possible adverse effects of clopidogrel, aspirin or other analgesics and anti-inflammatory drugs, steroids and warfarin in some short of combination; need to approach their physician to review the prescription. Their physician will judge the combinations on risks and benefits ratio; and may individualize an advice.
