Current consensus guidelines recommend the use of proton pump inhibitors (PPIs) for the prevention of gastrointestinal bleeding in patients receiving dual antiplatelet therapy (DAPT) with clopidogrel and aspirin. Metabolism of both PPIs and clopidogrel involves the cytochrome-P450 (CYP450) system. Concomitant use of these drugs may result in the competitive inhibition of CYP2C19 and reduced clopidogrel action. The evidence available to date for a drug interaction is conflicting and relies heavily on observational data. Until further evidence become available, it is recommended that health care professionals avoid the concomitant use of clopidogrel and PPIs unless absolutely necessary and only when there is a clear indication such as for peptic ulcer disease or H. pylori eradication. Pantoprazole may be the preferred PPI although current evidence are inconclusive. H2 antagonists may be a suitable alternative to PPIs.
 

根據2010年專家共識文件，接受雙重抗血小板治療（DAPT）的病患，應同時併用氫離子幫浦抑制劑 (PPIs)，以預防抗血小板藥物所引起的消化道不良反應。PPIs與clopidogrel都經由cytochrome-P450 (CYP450)進行代謝。PPIs會抑制CYP2C19活性，因此與clopidogrel併用時，可能會影響clopidogrel療效，甚至增加心血管不良事件的發生。到目前為止，有關clopidogrel和PPI交互作用的研究都屬於觀察性研究，而且結果有矛盾，臨床應用有限。然而，直到有進一步的證據，建議除非有必要，clopidogrel應避免與PPI併用。理論上pantoprazole比較不會與clopidogrel產生交互作用，但目前的證據是不確定的。H2接受體拮抗劑是PPIs的另外一個選擇。