MajorAntiplatelet agents – P2Y12 receptor inhibitors×SSRI
Updated · Methodology
Mechanism
Clopidogrel is a prodrug, activated by CYP2C19. Fluvoxamine is a potent CYP2C19 inhibitor. The active clopidogrel metabolite is not formed and antiplatelet effect is lost.
Symptoms
The patient feels no symptoms – the weakened antiplatelet effect is silent. The combination raises recurrent myocardial infarction, stent thrombosis, and stroke risks.
Management
The combination is not prescribed. Alternative antidepressants without CYP2C19 effect: sertraline or escitalopram (moderate but weaker effect), or mirtazapine/agomelatine (no effect). Alternative antiplatelet: ticagrelor (not CYP2C19-dependent).
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) — boxed warning CYP2C19 poor metabolizers (2010)– ; DailyMed setid de8b0b67-eb25-4684-83b5-7ad785314227
- AEMPS: Ficha técnica: Fluvoxamina (nº registro 63277), sección 4.5 (2024)– AEMPS, CIMA, nº registro 63277, sección 4.5