Moderate
Established
Description
Lansoprazole, like omeprazole, inhibits CYP2C19 and reduces clopidogrel's antiplatelet efficacy, potentially increasing cardiovascular event risk.
Mechanism
Lansoprazole inhibits CYP2C19, reducing the formation of clopidogrel's active thiol metabolite and impairing P2Y12 receptor blockade.
Clinical Significance
FDA and EMA communications note reduced platelet inhibition; pantoprazole is preferred when gastroprotection is needed.
Management
Switch to pantoprazole if PPI is needed in clopidogrel-treated patients; if lansoprazole must be used, monitor for cardiovascular events.