CYP-mediated pharmacologic interference with optimal platelet inhibition.

Variability of response to clopidogrel and prasugrel is a multifactorial process, with clinical consequences, and drug-drug interactions have been proposed as potential factors. Biological modulation of clopidogrel response has been demonstrated for atorvastatin and omeprazole. However, investigations assessing clinical relevance of these findings have been heterogeneous, and real clinical impact is still debatable. For new P2Y12 blockers, such as prasugrel, with less variability of platelet inhibition, these interactions are not significant; accordingly, no dose adjustment is required. The present review aims to summarize available scientific evidence about CYP-mediated pharmacologic interference with optimal platelet inhibition in patients treated with thienopyridine.