{"id":626603,"date":"2024-02-08T09:18:47","date_gmt":"2024-02-08T14:18:47","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=626603"},"modified":"2024-10-25T10:10:28","modified_gmt":"2024-10-25T14:10:28","slug":"clopidogrel-interactions","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/clopidogrel-interactions\/","title":{"rendered":"Clopidogrel interactions to avoid"},"content":{"rendered":"

Avoiding a heart attack and stroke is at the top of everyone’s priority list for their health, particularly for those who have suffered one in the past or have a coronary stent in place. <\/span>Clopidogrel<\/span><\/a> can be an ally in that endeavor, but only if drug interactions do not compromise the medication’s action. Clopidogrel functions as an antiplatelet agent by blocking the glycoprotein IIb\/IIIa receptor activation. Inhibiting platelet blood cells makes the blood thinner, and how the drug is metabolized in the body makes clopidogrel susceptible to interactions with various medications and even some foods. If you are about to start or are already taking clopidogrel, better known by its brand name <\/span>Plavix<\/span><\/a>, you need to know these interactions.<\/span><\/p>\n

Clopidogrel drug interactions<\/span><\/h2>\n

Either amplifying or minimizing the action of clopidogrel can be a big deal when it comes to drug-drug interactions. You certainly don’t want to be at risk of hemorrhaging from too much platelet inhibition, but you also want clopidogrel to be able to do its thing by helping to prevent cardiovascular events. These grave events could include acute coronary syndromes, unstable angina, and myocardial infarctions.<\/span><\/p>\n

Proton pump inhibitors<\/span><\/h3>\n

PPIs<\/span><\/a> are probably one of the more used (and overused) drug classes, partly because acid reflux is common, plus they work well and are hard to discontinue. For these reasons, they end up on many patient’s medication lists. Their ubiquitous presence should not be misconstrued as being innocuous, and their interaction with clopidogrel is a perfect example.<\/span><\/p>\n

PPIs can nullify the antiplatelet effects of clopidogrel, which could <\/span>heighten the risk of a cardiovascular event<\/span><\/a>. The mechanism of the interaction is thought to be the inhibition of a liver enzyme, CYP2C19, which is required to convert clopidogrel to its active state. <\/span><\/p>\n

Among the PPIs, <\/span>Prilosec<\/span><\/a> (omeprazole) and <\/span>Nexium<\/span><\/a> (esomeprazole) are felt to be the biggest offenders and are usually avoided in combination with Plavix. <\/span>Prevacid<\/span><\/a> (lansoprazole) and <\/span>Protonix<\/span><\/a> (pantoprazole) may have less negative interaction, and <\/span>Aciphex<\/span><\/a> (rabeprazole) and <\/span>Dexilant<\/span><\/a> (dexlansoprazole) could be most preferable if a PPI is needed, based on having the least interaction. The need for both a PPI and Plavix should be reviewed with the prescribing providers to discuss any potential PPI or <\/span>clopidogrel alternatives<\/span><\/a>. If price is an issue in switching, check out the <\/span>SingleCare discount card<\/span><\/a> for savings.<\/span><\/p>\n

CYP enzyme inhibitors<\/span><\/h3>\n

CYP enzymes are frequently involved in the metabolism of drugs, including clopidogrel. Besides PPIs, other drugs can influence clopidogrel metabolism through CYP enzyme inhibition and lead to less antiplatelet action. Members of the azole <\/span>antifungal class<\/span><\/a>, including <\/span>Diflucan<\/span><\/a> (fluconazole) and <\/span>Ketodan<\/span><\/a> (ketoconazole) may negatively affect Plavix activity, and ritonavir, one of the components of <\/span>Paxlovid<\/span><\/a> (nirmatrelvir-ritonavir) which is used for treating COVID-19, can do so as well. Get input from your medical provider about whether these interactions with clopidogrel require a change to be made.<\/span><\/p>\n

Anticoagulants<\/span><\/h3>\n

Going the other direction with a clopidogrel interaction, anticoagulants can cause bleeding when taken alongside the antiplatelet agent. This duo is often necessary and recommended by cardiologists and neurologists. Nonetheless, you need to be aware of it and talk to these specialists or your primary care provider about the balance of <\/span>side effects<\/span><\/a> and benefits.<\/span><\/p>\n

Drugs that could additively thin the blood with clopidogrel include anticoagulants and antiplatelet agents, including <\/span>nonsteroidal anti-inflammatory drugs (NSAIDs)<\/span><\/a>. Examples of drugs in these different categories include:<\/span><\/p>\n