Prescribing Proton Pump Inhibitor and Clopidogrel Together

Current State of Recommendations

Neena S. Abraham


Curr Opin Gastroenterol. 2011;27(6):558-564. 

In This Article


The evolution of data over the last 2 years has demonstrated that, when clinical decisions are based on conflicting observational data using surrogate clinical endpoints, incorrect assumptions regarding drug interactions are made. The publication of the COGENT trial has highlighted the importance of randomized controlled data to support the use of PPI gastroprotection in patients co-prescribed clopidogrel. A multidisciplinary consensus document highlights a risk–benefit assessment strategy for all patients prescribed clopidogrel and recommends PPI gastroprotection for those at highest risk of gastrointestinal bleeding as they are most likely to benefit from the marked reduction in gastrointestinal bleeding risk. Further characterization of the genetic variation in both PPI and clopidogrel drug metabolism should help elucidate the subset of cardiac patients in whom PPI prescription may be disadvantageous.


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