In their comprehensive review of antithrombotic agents following acute coronary syndromes, Matteau and Bhatt1 discuss the drug interaction between proton pump inhibitors and clopidogrel. They note that the COGENT trial, led by Bhatt, found no increased risk of major cardiovascular events at six months in patients receiving omeprazole with clopidogrel.2
The COGENT trial employed a proprietary product containing omeprazole and clopidogrel (CGT-2168) purposefully formulated to circumvent any drug interaction by releasing the two drugs separately.3,4 It offers no information about the safety of omeprazole and clopidogrel in patients who take clinically available products together.
A large and growing body of evidence suggests that omeprazole and pantoprazole exert differential effects on the antiplatelet effect of clopidogrel.5,6 Although the clinical significance of the interaction remains the subject of debate, there is no compelling reason to use omeprazole rather than pantoprazole in this setting.
References
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