Moderate
Probable
Descripción
Fluoxetine may reduce clopidogrel's antiplatelet efficacy by inhibiting CYP2C19-mediated bioactivation while also independently impairing platelet serotonin-mediated aggregation.
Mecanismo
Fluoxetine and norfluoxetine inhibit CYP2C19, reducing clopidogrel activation; paradoxically, fluoxetine's platelet serotonin depletion may partially offset this, but the net antiplatelet effect is uncertain.
Relevancia clínica
The clinical outcome impact is not well quantified; caution is warranted in high-risk cardiovascular patients on clopidogrel.
Manejo clínico
Prefer escitalopram or sertraline (weaker CYP2C19 inhibition) when an SSRI is needed alongside clopidogrel.