ClotCare: Blood Clots, Stroke, Heart Attack
Sunday, May 26, 2024
Home   |   DVT/PE   |   Blood Clots   |   Coumadin/Warfarin   |   New Patients   |   Self Testing   |   Email List   |   Donate

Pick a Topic:

Find info on a:

We subscribe to the HONcode principles of the HON Foundation. Click to verify.
ClotCare complies with the HONcode standard for trustworthy health
verify here.

ClotCare is a member of the Coalition to Prevent Deep Vein Thrombosis (DVT Coalition)  ClotCare is a member organization of the Coalition to Prevent Deep Vein Thrombosis. Click here to learn more about the Coalition to Prevent Deep Vein Thrombosis and DVT Awareness Month, which is held each March.

Leading cardiologists challenge clinical importance of interaction between clopidogrel (Plavix) and omeprazole (Prilosec) and question the wisdom of the FDA alert advising AGAINST use of these drugs together

Henry I. Bussey, Pharm.D., FCCP, FAHA
March, 2010

Since ClotCare reviewed this issue in May, 2009 (see, information has continued to accumulate on the potential of omeprazole and other drugs to inhibit the CYP 2C19 enzyme which converts clopidogrel to its active metabolite. In addition to omeprazole and exomeprazole, the FDA letter also advises against the use of cimetidine (Tagamet), fluconazole (Diflucan), ketoconazole (Nizoral), voriconazole (VFEND), etravirine (Intelence), felbamate (Felbatol), fluoxetine (Prozac, Serafem, Symbyax), fluvoxamine (Luvox), and ticlopidine (Ticlid).

Although the potential interaction has been cited to result in as much as a 45% reduction in the plasma concentration of the active metabolite of clopidogrel, a posting dated November, 18, 2009 on the ( presents the views of several leading cardiologists who disagree with the FDA's new position. Specifically, the cardiologists do not disagree with the fact that the cited drugs may reduce the conversion of clopidogrel to its active metabolite; but rather point to several articles in which use of these interacting drugs was NOT found to be related to event rates or clinical outcomes.

The letter indicated that the FDA did not have enough data to advise against the use of other proton pump inhibitors (PPIs) and further indicated that there was no evidence of an interaction with the histamine-2 (H2) blockers ranitidine (Zantac), famotidine (Pepcid), nizatidine (Axid) or antacids.

The FDA alert is available at:

The posting is available at:

Ask a question about blood clots or anticoagulant medications Have questions? Ask ClotCare. Send questions by email to

ClotCare is a 501(c)(3) non-profit organization generously supported by your tax-deductible donations and grants from our industry supporters.

Blood Clot Activities Calendar

New Postings:

Click here to view full list of new postings
ClotCare Home | New Postings | Patient Postings | Clinician Postings | Join Our Email List | Useful Web Links
CE Opportunities | Training Programs | DVT & PE Stories | Editorial Board | Financial Support
About ClotCare | DVT Coalition | Donate to ClotCare | Contact Us
Key topics discussed on ClotCare include: Blood Clots | Deep Vein Thrombosis (DVT) | Pulmonary Embolism (PE) | Atrial Fibrillation (A. Fib or AF) | Heart Attack | Stroke | Transient Ischemic Attack (TIA) | Mini Stroke | Bleeding Complications | Vascular Surgery | Surgical Blood Clot Removal | Warfarin | Coumadin | Lovenox | Low Molecular Weight Heparin (LMWH) | Heparin | Anticoagulants | Plavix | Aspirin | Antiplatelets | Blood Thinners
Copyright 2000-2018 by ClotCare. All rights reserved.
Terms, Conditions, & Privacy | Image Copyright Information
19260 Stone Oak Parkway, Suite 101 | San Antonio, TX 78258 | 210-860-0487
Send comments to
Sunday, May 26, 2024