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PPI choice with clopidogrel — GPhC CRA MCQ

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ModerateGI TherapeuticsPPI choice with clopidogrelGPhC CRA

A 69-year-old woman taking clopidogrel after an ischaemic stroke asks to buy omeprazole for frequent reflux. She has no alarm symptoms but has had indigestion most evenings for 3 weeks. Her repeat medicines include atorvastatin and amlodipine. What is the most appropriate alternative?

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Correct answer: B — lansoprazole with advice to seek GP review if symptoms persist

Omeprazole and esomeprazole can reduce conversion of clopidogrel to its active metabolite and are best avoided. Lansoprazole or pantoprazole are commonly preferred PPI options when gastroprotection or reflux treatment is required with clopidogrel. Persistent or recurrent symptoms still need appropriate review, particularly in an older person. NSAIDs would increase gastrointestinal risk and are inappropriate for reflux symptoms.

Reference: BNF; NICE CKS: Dyspepsia