clopidogrel

Omeprazole or Esomeprazole Avoid concomitant use of clopidogrel with omeprazole or esomeprazole. In clinical studies, omeprazole was shown to reduce significantly the antiplatelet activity of clopidogrel when given concomitantly or 12 hours apart. A similar reduction in antiplatelet activity was observed with esomeprazole when given concomitantly with clopidogrel.

Mechanism: Omeprazole stops clopidogrel from working correctly by preventing it from turning into its active form. This makes the medicine less effective at stopping blood clots.

What to do: Avoid taking these two drugs together. Your doctor may suggest a different medicine for your stomach.

( 7.3 ) Nonsteroidal anti-inflammatory drugs (NSAIDs), warfarin, selective serotonin and serotonin norepinephrine reuptake inhibitors (SSRIs, SNRIs): Increases risk of bleeding. 7.5 Warfarin (CYP2C9 Substrates) Although the administration of clopidogrel 75 mg per day did not modify the pharmacokinetics of S-warfarin (a CYP2C9 substrate) or INR in patients receiving long-term warfarin therapy, coadministration of clopidogrel with warfarin increases the risk of bleeding because of independent effects on hemostasis.

Mechanism: Both medicines work to prevent blood clots, but they do it in different ways. Using them together makes it much easier for you to bleed or bruise.

What to do: Monitor yourself closely for any unusual bleeding or bruising. Your doctor will need to check your health frequently while you are on both drugs.

Omeprazole or Esomeprazole Avoid concomitant use of clopidogrel with omeprazole or esomeprazole. A similar reduction in antiplatelet activity was observed with esomeprazole when given concomitantly with clopidogrel. Dexlansoprazole, lansoprazole, and pantoprazole had less effect on the antiplatelet activity of clopidogrel than did omeprazole or esomeprazole [see Warnings and Precautions (5.1) and Clinical Pharmacology (12.3) ].

Mechanism: Esomeprazole keeps clopidogrel from being activated in your body. This prevents the blood thinner from doing its job of protecting your heart and blood vessels.

What to do: You should avoid this combination. Talk to your doctor about using a different stomach medicine that does not interfere with your treatment.

Rifampin strongly induces CYP2C19 resulting to both an increase level of clopidogrel active metabolite and platelet inhibition, which in particular might potentiate the risk of bleeding.

Mechanism: Rifampin speeds up the process that turns clopidogrel into its active form in the body. This leads to higher levels of the active drug, which can make your blood too thin and increase the risk of bleeding.

What to do: Your doctor should monitor you closely for signs of bleeding while taking these drugs together. They may need to adjust your treatment plan to ensure your safety.

( 7.3 ) Nonsteroidal anti-inflammatory drugs (NSAIDs), warfarin, selective serotonin and serotonin norepinephrine reuptake inhibitors (SSRIs, SNRIs): Increases risk of bleeding. 7.6 SSRIs and SNRIs Since selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) affect platelet activation, the concomitant administration of SSRIs and SNRIs with clopidogrel may increase the risk of bleeding.

Mechanism: Both of these medications affect how your blood cells, called platelets, stick together to form clots. Taking them at the same time can make it harder for your blood to clot, which raises the risk of bleeding.

What to do: Use caution when taking these medications together and watch for unusual bruising or bleeding. Tell your doctor immediately if you notice any signs of bleeding.