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