Indication:STEMI, NSTEMI in combination with low dose aspirin (including stent placement following PCI) and Acute Coronary Syndrome.
For people who have had an ischaemic stroke or who have peripheral arterial disease or multivascular disease or for people who have had a myocardial infarction only if aspirin is contraindicated or not tolerated.
NICE TA 210
Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events December 2010
* Concomitant use of clopidogrel and omeprazole or esomeprazole is to be discouraged unless considered essential
* Doctors should check whether patients who are taking clopidogrel are also buying over-the-counter omeprazole and consider whether other gastrointestinal therapies would be more suitable
* Pharmacists should check whether patients buying omeprazole are also taking clopidogrel
* Consider PPIs other than omeprazole or esomeprazole in patients who are taking clopidogrel. Other gastrointestinal therapy such as H2 blockers (except cimetidine) or antacids may be more suitable in some patients
* Discourage concomitant use of other known CYP2C19-inhibiting medicines with clopidogrel because these are expected to have a similar effect to omeprazole and esomeprazole (CYP2C19 inhibitors include fluvoxamine, fluoxetine, moclobemide, voriconazole, fluconazole, ticlopidine, ciprofloxacin, cimetidine, carbamazepine, oxcarbazepine, and chloramphenicol)
MHRA Drug Safety Update Volume 3 Issue 9 April 2010
Full guidance for Clopidogrel and Prasugrel use in Primary and Secondary care can be found on the Medicines Management website.