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PPI-clopidogrel interaction management — GPhC CRA MCQ

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ModerateDrug InteractionsPPI-clopidogrel interaction managementGPhC CRA

A 55-year-old woman currently taking omeprazole 20 mg daily for GORD presents with a new prescription for clopidogrel 75 mg daily. She has just had a coronary stent fitted. The pharmacist notes a potential interaction. What is the most appropriate action?

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Correct answer: E — Contact the prescriber to discuss switching omeprazole to lansoprazole or pantoprazole

Omeprazole inhibits CYP2C19 and can reduce the antiplatelet effect of clopidogrel. The MHRA advises avoiding omeprazole (and esomeprazole) in patients taking clopidogrel. Alternative PPIs such as lansoprazole or pantoprazole have less effect on CYP2C19 and are preferred. Stopping GI protection entirely may not be appropriate if there is an indication for PPI therapy. The prescriber should be contacted to discuss the switch.

Reference: BNF Drug Interactions; MHRA Drug Safety Update