MajorAntiplatelet agents – P2Y12 receptor inhibitors×Drugs for peptic ulcer and GORD. Proton pump inhibitors
Updated · Methodology
Mechanism
Esomeprazole inhibits CYP2C19, the key enzyme that converts clopidogrel to its active metabolite. Active clopidogrel levels fall by about 35%, weakening antiplatelet effect.
Symptoms
The patient feels no symptoms – the weakened antiplatelet effect is silent. The combination raises recurrent myocardial infarction and stent thrombosis risk in patients with prior stenting or acute coronary syndrome.
Management
Replace esomeprazole with pantoprazole (minimal CYP2C19 impact). Among other PPIs, rabeprazole is an alternative. If a PPI is not required, switch to famotidine (H2-blocker) or stop acid suppression.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- FDA: Plavix (clopidogrel) prescribing information (2009)– ; DailyMed setid de8b0b67-eb25-4684-83b5-7ad785314227
- AEMPS: Ficha técnica: Esomeprazol (nº registro 63436), sección 4.5 (2025)– AEMPS, CIMA, nº registro 63436, sección 4.5
- AEMPS: Ficha técnica: Clopidogrel (nº registro 71676), sección 4.5 (2024)– AEMPS, CIMA, nº registro 71676, revisión 02/2024, sección 4.5