OBJECT DRUGS

• Clopidogrel (Plavix)

PRECIPITANT DRUGS

• Chloramphenicol
• Cimetidine (Tagamet, etc.)
• Delavirdine (Rescriptor)
• Efavirenz (Sustiva)
• Esomeprazole (Nexium, etc.)
• Fluoxetine (Prozac, etc.)
• Fluvoxamine (Luvox, etc.)
• Isoniazid (INH)
• Omeprazole (Prilosec, etc.)
• Ticlopidine (Ticlid)
• Voriconazole (Vfend)

Comment:

Inhibitors of CYP2C19 may reduce the metabolism of clopidogrel to its active metabolite. Some reduction in antiplatelet activity and clinical efficacy may occur. Inhibitors of other enzymes that metabolize clopidogrel to its active metabolite (CYP3A4, CYP2C9) may also reduce the efficacy of clopidogrel.

Class 3: Assess Risk & Take Action if Necessary

• Consider Alternative: Other PPIs may be less likely to interact with clopidogrel than omeprazole or esomeprazole.
• Monitor:Monitor for reduced antiplatelet activity in patients taking clopidogrel and drugs that inhibit its conversion to the active metabolite.