Clopidogrel with Fluvoxamine Interaction Details
Brand Names Associated with Clopidogrel
- Clopidogrel
- Plavix®
Brand Names Associated with Fluvoxamine
- Fluvoxamine
- Luvox®
- Luvox® CR
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 11, 2023
Interaction Effect
Reduction in clinical efficacy of clopidogrel and reduced platelet inhibition; increased risk of bleeding
Interaction Summary
Clopidogrel is metabolized to its active metabolite by CYP2C19. Concomitant use of clopidogrel and fluvoxamine (strong CYP2C19 inhibitor) may reduce clopidogrel active metabolite concentrations and reduced platelet inhibition. Additionally, concomitant use may increase the risk of bleeding, as the release of serotonin by platelets is important for maintaining hemostasis . In a meta-analysis, there was a significant 11% increased risk of ischemic events when coadministered. Consider treatment with an SSRI that is not a CYP2C19 inhibitor .
Severity
Major
Onset
Unspecified
Evidence
Established
How To Manage Interaction
Concomitant use of clopidogrel and fluvoxamine has the potential for reduced clopidogrel active metabolite concentrations and reduced platelet inhibition. Concomitant use may also increase the risk of bleeding. Consider treatment with an SSRI that is not a CYP2C19 inhibitor, such as citalopram, escitalopram, paroxetine, and sertraline .
Mechanism Of Interaction
Inhibition of CYP2C19-mediated clopidogrel metabolism to its active metabolite by fluvoxamine; unknown
Literature Reports
A) Initiation of clopidogrel in patients receiving a CYP2C19-inhibiting SSRI (n=9281; 97.5% fluoxetine; 2.5% fluvoxamine) resulted in a small but significant 12% increased risk of any ischemic event (95% CI, 1.01 to 1.24) compared with non-CYP2C19-inhibiting SSRIs (n=44,278) in a propensity-score matched cohort study. CYP2C19-inhibiting SSRIs were also associated with a significant 18% increased risk of a stent procedure, and at 17% increased risk of PTCA. In patients 65 years or older, there was a nonsignificant 22% increased risk of any ischemic event, a significant 39% increased risk of stenting, and a significant 38% increased risk of PTCA . Initiation of a CYP2C19-inhibiting SSRI (n=2350; 98% fluoxetine; 2% fluvoxamine) in patients receiving clopidogrel resulted in a nonsignificant 7% (95% CI, 0.82 to 1.4) increased risk of any ischemic event compared with non-CYP2C19-inhibiting SSRIs (n=16,115) in a propensity-score matched cohort study. In a meta-analysis of pooled results regardless of the order of drug initiation, there was a significant 11% (95% CI, 1.01 to 1.22) increased risk of any ischemic event and no significant difference in the composite bleeding outcome .
Clopidogrel Overview
-
Clopidogrel is used alone or with aspirin to prevent serious or life-threatening problems with the heart and blood vessels in people who have had a stroke, heart attack, or severe chest pain. This includes people who have percutaneous coronary intervention (PCI; angioplasty; a type of heart surgery) that may involve inserting coronary stents (metal tubes surgically placed in clogged blood vessels to improve blood flow) or who have coronary artery bypass grafting (CABG; a type of heart surgery). Clopidogrel is also used to prevent serious or life-threatening problems with the heart and blood vessels in people who have peripheral arterial disease (poor circulation in the blood vessels that supply blood to the legs). Clopidogrel is in a class of medications called antiplatelet medications. It works by preventing platelets (a type of blood cell) from collecting and forming clots that may cause a heart attack or stroke.
Fluvoxamine Overview
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Fluvoxamine is used to treat obsessive-compulsive disorder (bothersome thoughts that won't go away and the need to perform certain actions over and over) and social anxiety disorder (extreme fear of interacting with others or performing in front of others that interferes with normal life). Fluvoxamine is in a class of medications called selective serotonin reuptake inhibitors (SSRIs). It works by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.