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Clopidogrel and PPI — GPhC CRA MCQ

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ModerateGI TherapeuticsClopidogrel and PPIGPhC CRA

A 67-year-old man takes clopidogrel 75mg daily after a TIA and requests omeprazole for indigestion. He has recurrent reflux symptoms and no alarm features. What is the most important interaction to flag?

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Correct answer: A — Omeprazole can reduce clopidogrel activation; consider an alternative acid suppressant

Omeprazole and esomeprazole can inhibit CYP2C19 and reduce conversion of clopidogrel to its active metabolite. A PPI with less CYP2C19 inhibition, or another suitable approach, should be discussed if gastroprotection or reflux treatment is needed. Spacing doses does not reliably avoid this interaction. The choice should consider the patient's gastrointestinal risk and indication for antiplatelet therapy.

Reference: BNF; NICE CKS Dyspepsia