4 known interactions • 1 major • 2 moderate • 1 minor
Always disclose all medications to your healthcare providers — prescription medicines, OTC medications, vitamins, and herbal supplements. This list may not include every possible interaction. Use our Medicine Interaction Checker to screen your complete medication list.
Potentially life-threatening or causing permanent damage. Avoid combination.
May worsen condition or require dose adjustment. Monitor closely.
Usually limited clinical effect. Manage with routine monitoring.
Anticoagulants (warfarin, DOACs)
Triple therapy (anticoagulant + aspirin + clopidogrel) substantially increases bleeding risk. Sometimes required post-ACS in AF patients.
Management: Limit duration of triple therapy; use proton pump inhibitor; lowest aspirin dose.
Omeprazole / esomeprazole (PPIs)
CYP2C19 inhibition by these PPIs reduces conversion of clopidogrel to its active metabolite, reducing antiplatelet effect. The clinical significance remains debated.
Management: Use pantoprazole or another PPI with less CYP2C19 inhibition if GI protection needed.
NSAIDs
Additive bleeding risk. NSAIDs also partially antagonize antiplatelet effect via reversible COX-1 inhibition.
Management: Avoid NSAIDs; use acetaminophen for pain.
Aspirin
Synergistic antiplatelet effect when used in DAPT — intended combination. Both increase bleeding risk.
Always ask your pharmacist about potential interactions with food, alcohol, and supplements specific to Clopidogrel. Some medicines have significant interactions with grapefruit juice, high-fat meals, dairy products, or vitamin K-rich foods.