RiteMED Clopidogrel Drug Interactions

Aspirin: Clopidogrel may potentiate aspirin's antithrombotic effects resulting in increased risk of bleeding.
Nonsteroidal Anti-inflammatory Drugs (NSAIDs) [e.g., Naproxen, Ibuprofen, Diclofenac]: Increased occult GI blood loss has also been reported concomitant use with NSAIDs. Co-administer with caution.
Anticoagulants: Concomitant use of clopidogrel with anticoagulants (e.g., warfarin, argatroban, enoxaparin, bivalirudin, heparin) may cause increased risk of bleeding.
Drugs Metabolized by CYP2C9 Isoenzyme: Clopidogrel may inhibit the cytochrome P450 isoenzyme CYP2C9 and interactions with drugs metabolized by this isoenzyme (e.g., phenytoin, tamoxifen, tolbutamide, warfarin, torsemide, fluvastatin, and NSAIDs) are possible.
Bupropion: Clopidogrel has been found to reduce the conversion of bupropion to its active metabolite suggesting that clopidogrel inhibits cytochrome P450 isoenzyme CYP2B6.
Statins and Ciclosporin: Rhabdomyolysis has been reported to develop in patients administered with clopidogrel in addition to ciclosporin and a statin (e.g., atorvastatin, lovastatin or simvastatin). It has been suggested that the mechanism is a three-way interaction involving competition for binding sites on cytochrome P450 isoenzyme CYP3A4 between statins and clopidogrel, exacerbated by ciclosporin-mediated enzyme inhibition.
Macrolide Antibiotics: CYP3A4-inhibiting macrolides (e.g., clarithromycin, erythromycin and troleandomycin) may attenuate the effects of clopidogrel.