There is a major drug interaction between Plavix (clopidogrel) and Nexium (esomeprazole).
GENERALLY AVOID: Coadministration with proton pump inhibitors (PPIs) may reduce the cardioprotective effects of clopidogrel. The proposed mechanism is PPI inhibition of the CYP450 2C19-mediated metabolic bioactivation of clopidogrel. This is consistent with studies that reported decreased effectiveness of clopidogrel in patients who have common genetic polymorphisms of CYP450 2C19 resulting in reduced or absent enzyme activity.
MANAGEMENT: Until further data are available, patients treated with clopidogrel should preferably avoid the use of proton pump inhibitors. H2-receptor antagonists or antacids should be considered whenever possible.
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