Moderate
Established
설명
Omeprazole reduces the antiplatelet efficacy of clopidogrel by inhibiting its bioactivation via CYP2C19, potentially increasing thrombotic risk.
기전
Clopidogrel requires CYP2C19-mediated hepatic activation to form its active thiol metabolite; omeprazole inhibits CYP2C19, reducing active metabolite formation and platelet inhibition.
임상적 중요성
Platelet inhibition decreases by ~30–47%; clinical outcomes data are mixed, but the FDA and EMA have issued communications warning about this interaction.
관리 방법
Prefer pantoprazole (weaker CYP2C19 inhibition) over omeprazole when a PPI is needed with clopidogrel. Avoid omeprazole or esomeprazole if possible.