Interactie tussen clopidogrel en protonpompremmers

Conflict of interest: none declared. Financial support: none declared.

• The drug interaction between proton pump inhibitors and clopidogrel has been the subject of much study in recent years.

• Contradictory results regarding the effect of proton pump inhibitors on platelet reactivity and on clinical outcome in clopidogrel-treated patients have been reported in literature.

• Concomitant use of omeprazole and clopidogrel was found to decrease the exposure (AUC) to clopidogrel’s active metabolite by 50% and to sharply increase platelet reactivity, as a result of inhibition by omeprazole of CYP2C19, a cytochrome P450 (CYP) enzyme.

• Pantoprazole has a much weaker effect on clopidogrel’s pharmacokinetics and on platelet reactivity during concomitant use.

• The influence of the other proton pump inhibitors when used simultaneously with clopidogrel has not yet been investigated in adequately randomized studies.

• Regulatory agencies state that the combination of clopidogrel and the CYP2C19 inhibitors omeprazole and esomeprazole should be avoided.

• To date, there is no conclusive evidence of a clinically-relevant interaction between any of the proton pump inhibitors and clopidogrel.