clopidogrel/omeprazole interractions

[momander]

Thank you everyone for your posts regarding this. I would not have known that taking omeprazole and clopidogrel together could potentially be dangerous, had I not read it on this forum last year by a complete fluke!!! It seems as if some people here are still taking this combination and others are not. I guess it may depend on advice from health care professionals, and of what their beliefs are. I checked this last year as it gave me a bit of a fright. According to the British National Formulary which is a pharmaceutical reference book used by pharmacists and doctors, it states that omeprazole is predicted to decrease the efficacy of clopidogrel. Manufacturer advises avoid. My GP wants me to be on aspirin AND clopidogrel even though I only had a mild heart attack? Apparantly pantoprazole is the safest PPI you can take with clopidogrel but is is very expensive so not normally prescribed. Maybe I should ask for an alternative to clopidogrel? I find the omeprazole better than the lansoprazole.

[Platypus6]

Hi momander being one of the many hearties who takes clopidogrel, I was advised some time ago to come off omeprazole and esomeprazole as it reduces the effect of clopidogrel. I have been taking pantoprazole for over a year now.

[Hullensian]

I would query taking Clopidogrel and Aspirin due to the fact that when my husband was discharged from hospital a week ago, a Consultant removed Aspirin from his medication list and replaced it with Clopidogrel. Plus, we were at the Surgery today for blood tests and were informed that one should not take Aspirin and Clopidogrel together.

[momander in reply to Hullensian]

Isn't it strange how all health care professionals differ in their opinions!? In the BNF there are no interactions between clopidogrel and aspirin, they both do completely different things. Aspirin is a blood thinner whereas clopidogrel keeps the platelets in the blood nice and clean and prevents them from becoming sticky. Aspirin is given to nearly every patient once they have had a heart attack or stroke, it is the first thing the ambulance service do!! Then the cardiologist s do the same. A blood thinner, beta blocker, station and platelet drug is the standard cocktail in most hospitals. I would like to say every hospital but I may be corrected. Also I would like to say aspirin is given to everyone,but again * may be corrected. I recently had a meds review and everything I am on was discussed and was agreed to be correct. This was in hospital!! My GP agreed that everything I take is safe and no interactions between any of them. I'm happy with that.

[Hidden in reply to Hullensian]

Clopidogrel and aspirin can be safely taken together and frequently are by many people after a heart attack. What NICE do say is that they shouldn’t be taken together for a period in excess of 12 months unless there is good grounds for dual anti-platelet therapy to continue, and that the combination should potentially be used for shorter periods in people that have had a STEMI. In various places under section 1.4 of the most up to date guidelines on managing patients that have had a heart attack, it clearly states that aspirin and Clopidogrel can be safely given together:

nice.org.uk/guidance/ng185/...

That’s not to say your husband’s consultant is wrong to stop the aspirin, but it does mean that the GP may be less well informed than they think they are, or they’ve made that comment in relation to something specific to your husband’s history that means it’s not appropriate in his case, as per the information in the link above. My experience medically has very much been that what’s appropriate for one person may be different for another depending on circumstances and history, and different consultants also sometimes have preferred ways of managing their patients based on their professional experience.

[Hullensian in reply to Hidden]

Very Interesting response. Obviously well researched, thank you. It is a minefield of not knowing which medical professional to "trust".