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TIA Secondary Prevention — MRCGP AKT MCQ

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HardNeurology/CardiologyTIA Secondary PreventionMRCGP AKTUKMLAPARAPSA

A 70-year-old taking clopidogrel after a non-cardioembolic TIA develops dyspepsia requiring a proton-pump inhibitor. Which PPI is the most appropriate choice?

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Correct answer: A — Pantoprazole at standard daily dose

The best answer is “Pantoprazole at standard daily dose”. Omeprazole and esomeprazole inhibit CYP2C19 and can reduce formation of clopidogrel’s active metabolite, so they should be avoided when another PPI is suitable. Pantoprazole has a lower interaction potential and is an appropriate choice. Increasing the clopidogrel dose is not a validated way to overcome the interaction.

Reference: MHRA: Clopidogrel and proton pump inhibitors interaction: https://www.gov.uk/drug-safety-update/clopidogrel-and-proton-pump-inhibitors-interaction-updated-advice