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Clopidogrel and PPI choice — GPhC CRA MCQ

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HardCardiovascular TherapeuticsClopidogrel and PPI choiceGPhC CRA

A 76-year-old taking clopidogrel after an ischaemic stroke has a previous bleeding peptic ulcer and now needs PPI gastroprotection. The prescription is for omeprazole 20 mg daily. Which intervention is most appropriate?

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Correct answer: A — Ask the prescriber to use pantoprazole, lansoprazole or rabeprazole instead of omeprazole

This patient has a clear reason for gastroprotection, so omitting a PPI is not appropriate. Omeprazole and esomeprazole inhibit CYP2C19 and can reduce formation of clopidogrel’s active metabolite. SPS advises choosing lansoprazole, pantoprazole or rabeprazole when a PPI is needed. Clopidogrel should not be stopped or empirically doubled: the safe intervention is to clarify and substitute the interacting PPI while maintaining indicated antiplatelet therapy.

Reference: NHS SPS: Using clopidogrel with proton pump inhibitors: https://sps.nhs.uk/articles/using-clopidogrel-with-proton-pump-inhibitors-ppis/