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Line 152: This interaction is possible because omeprazole is an [[enzyme inhibitor\|inhibitor]] of the enzymes [[CYP2C19]] and [[CYP3A4]].<ref>{{cite journal \| vauthors = Shirasaka Y, Sager JE, Lutz JD, Davis C, Isoherranen N \| title = Inhibition of CYP2C19 and CYP3A4 by omeprazole metabolites and their contribution to drug-drug interactions \| journal = Drug Metabolism and Disposition \| volume = 41 \| issue = 7 \| pages = 1414–1424 \| date = July 2013 \| pmid = 23620487 \| pmc = 3684819 \| doi = 10.1124/dmd.113.051722 }}</ref> [[Clopidogrel]] is an inactive [[prodrug]] that partially depends on CYP2C19 for conversion to its active form. Inhibition of CYP2C19 may block the activation of clopidogrel, which could reduce its effects.<ref>{{cite journal \| vauthors = Lau WC, Gurbel PA \| title = The drug-drug interaction between proton pump inhibitors and clopidogrel \| journal = CMAJ \| volume = 180 \| issue = 7 \| pages = 699–700 \| date = March 2009 \| pmid = 19332744 \| pmc = 2659824 \| doi = 10.1503/cmaj.090251 }}</ref><ref>{{cite journal \| vauthors = Norgard NB, Mathews KD, Wall GC \| title = Drug-drug interaction between clopidogrel and the proton pump inhibitors \| journal = The Annals of Pharmacotherapy \| volume = 43 \| issue = 7 \| pages = 1266–1274 \| date = July 2009 \| pmid = 19470853 \| doi = 10.1345/aph.1M051 \| s2cid = 13227312 }}</ref> Almost all [[benzodiazepines]] are metabolised by the CYP3A4 and [[CYP2D6]] pathways, and inhibition of these enzymes results in a higher [[Area under the curve (pharmacokinetics)\|area under the curve]] (''i.e.'', the total effect over time of a given dose). Other examples of drugs dependent on CYP3A4 for their metabolism are [[escitalopram]],<ref>{{EMedicine\|article\|1879354\|Selective Serotonin Reuptake Inhibitors and CYP2D6}}</ref> [[warfarin]],<ref name="pmid12724615">{{cite journal \| vauthors = Daly AK, King BP \| title = Pharmacogenetics of oral anticoagulants \| journal = Pharmacogenetics \| volume = 13 \| issue = 5 \| pages = 247–252 \| date = May 2003 \| pmid = 12724615 \| doi = 10.1097/00008571-200305000-00002 }}</ref> [[oxycodone]], [[tramadol]], and [[oxymorphone]]. The concentrations of these drugs may increase if they are used concomitantly with omeprazole.<ref name=Stedman>{{cite journal \| vauthors = Stedman CA, Barclay ML \| title = Review article: comparison of the pharmacokinetics, acid suppression and efficacy of proton pump inhibitors \| journal = Alimentary Pharmacology & Therapeutics \| volume = 14 \| issue = 8 \| pages = 963–978 \| date = August 2000 \| pmid = 10930890 \| doi = 10.1046/j.1365-2036.2000.00788.x \| s2cid = 45337685 }}</ref> Omeprazole is also a competitive inhibitor of [[p-glycoprotein]], as are other PPIs.<ref>{{cite journal \| vauthors = Pauli-Magnus C, Rekersbrink S, Klotz U, Fromm MF \| title = Interaction of omeprazole, lansoprazole and pantoprazole with P-glycoprotein \| journal = Naunyn-Schmiedeberg's Archives of Pharmacology \| volume = 364 \| issue = 6 \| pages = 551–557 \| date = December 2001 \| pmid = 11770010 \| doi = 10.1007/s00210-001-0489-7 \| s2cid = 19990184 }}</ref>

Omeprazole: Difference between revisions