Drug interactions between clopidogrel and Lipitor
Results for the following 2 drugs: |
|
|---|---|
| clopidogrel | |
| Lipitor (atorvastatin) | |
Interactions between your selected drugs
atorvastatin ⇔ clopidogrel
Applies to: Lipitor (atorvastatin) and clopidogrel
MONITOR: The concomitant administration of atorvastatin may reduce the metabolic activation of the prodrug clopidogrel and its antiplatelet effects. The proposed mechanism is competitive inhibition of CYP450 3A4 enzymatic activity, which is responsible for the conversion of clopidogrel to its active metabolite. However, data have been conflicting. In a trial with coronary stent implant patients receiving clopidogrel 75 mg/day (n=44), the percent platelet aggregation was 34% with no atorvastatin, 58% with atorvastatin 10 mg, 74% with 20 mg, and 89% with 40 mg. Results from an in vitro study suggest that equimolar concentrations of atorvastatin inhibit clopidogrel metabolism by more than 90 %. However, in a post hoc analysis of a trial with percutaneous coronary intervention patients, no statistical differences in the incidence of bleeding, stroke, myocardial infarction, or death were found at 1 year with concomitant administration of clopidogrel 75 mg/day and CYP450 3A4-metabolized HMG-CoA reductase inhibitors (n=1001, atorvastatin, lovastatin, simvastatin, cerivastatin) or other statins (n=158, pravastatin, fluvastatin).
MANAGEMENT: Until more information is available, monitoring for altered efficacy of clopidogrel may be advisable if atorvastatin is coadministered with clopidogrel. Pravastatin, fluvastatin, and rosuvastatin are not metabolized by CYP450 3A4 and are theoretically not expected to interact with clopidogrel.
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