Using clopidogrel with proton pump inhibitors (PPIs)

[helvella]

A notice released by NHS England's Specialist Pharmacy Service four days ago.

Not directly thyroid related but we have a number of members on the medicines mentioned - though quite possibly not in the combinations detailed.

Using clopidogrel with proton pump inhibitors (PPIs)

Published 22 May 2023

Avoid the combined use of clopidogrel with omeprazole or esomeprazole due to a significant interaction. Other PPIs are considered safe with clopidogrel.

Risk of using the combination

Due to clopidogrel’s mechanism of action, it can cause gastrointestinal adverse effects such as bleeding, dyspepsia and ulceration. PPIs are often co-prescribed to reduce the risk of these adverse effects in high-risk patients.

But in using the combination to manage adverse effects, risks associated with using clopidogrel and PPIs due to an interaction are introduced. Clopidogrel is a pro-drug activated by the enzyme CYP2C19. Omeprazole and esomeprazole are inhibitors of this enzyme meaning concurrent use can reduce plasma levels of activated clopidogrel.

Although other PPIs can inhibit CYP2C19 to a lesser extent, clinically significant interactions have not been observed.

The rest of this notice freely accessible (at least, within the UK) here:

sps.nhs.uk/articles/using-c...

Calling out to some members who have mentioned clopidogrel in the last two years or so.

UKmale_hypo rambler123 Nesting jamjar67 Devonlad sobs1962 MrsSuzuki Hawthorns Mugs19

[helvella Administrator Thyroid UK]

Further recent views on use of clopidogrel:

NICE to recommend genetic testing before prescribing clopidogrel

The National Institute for Health and Care Excellence has said genetic testing before initiating clopidogrel is a cost-effective use of NHS resources for patients at risk of stroke.

pharmaceutical-journal.com/...

[JGBH]

Sorry… What is clopidogrel used for?

[helvella Administrator Thyroid UK in reply to JGBH]

Anti-platelet - effectively reduces clotting.

[JGBH]

Thank you …. I thought so but not sure and tbh tired of checking everything on Google…

[Nesting]

I was changed from omeprazole to lansoprazole.

[Khen89]

so the advice is usually switch to either lansoprazole (which in most NHS trusts in England is the recommended switch) or Pantoprazole is also only a moderate interaction and could be considered.

[Digger0]

I was on clopidogrel for 3 months after my ASD closure and the hospital changed my Omeprazole to Lansoprazole while I was on them.

[helvella Administrator Thyroid UK in reply to Digger0]

I'm pleased the several replies show there is awareness of this issue. But the SPS have obviously decided it isn't as widely know as they'd like.

[Digger0]

Mind you, I was treated at the Liverpool Heart and Chest hospital So would hope they knew about it!