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Coadministration of either a CYP2C19 or a CYP3A4 inhibitor may also reduce clopidogrel's antiplatelet effects and lead to phenoconversion in patients without a\n                    <jats:italic>CYP2C19<\/jats:italic>\n                    no\u2010function allele (normal\/rapid\/ultrarapid metabolizers: NM\/RM\/UMs). However, the impact of CYP2C19 or CYP3A4 inhibitor use on clopidogrel clinical effectiveness remains unclear. Rates of major atherothrombotic events (MAE) over 12\u2009months after percutaneous coronary intervention (PCI) were evaluated in 3,242 patients across three sites who underwent\n                    <jats:italic>CYP2C19<\/jats:italic>\n                    genotype testing and received P2Y\n                    <jats:sub>12<\/jats:sub>\n                    inhibitor therapy. Overall, 6.8% of patients were co\u2010prescribed a moderate or strong inhibitor of either CYP2C19 or CYP3A4, as defined by the U.S. Food and Drug Administration. In\n                    <jats:italic>CYP2C19<\/jats:italic>\n                    genotype\u2010predicted NM\/RM\/UMs treated with clopidogrel (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20091,624), the MAE rates were numerically higher, but not significantly different in patients receiving either a CYP2C19 or a CYP3A4 inhibitor vs. no inhibitor (18.4 vs. 12.8 events\/100 patient\u2010years, adjusted hazard ratio (HR) 1.51, 95% confidence interval (CI), 0.85\u20132.68,\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.155). When evaluating CYP2C19 inhibitor and CYP3A4 inhibitor use separately, MAE rates were higher in clopidogrel\u2010treated NM\/RM\/UMs receiving a CYP2C19 inhibitor compared to no inhibitor (adjusted HR 2.22, 95% CI 1.01\u20134.91,\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.048), but no significant difference was observed in those receiving a CYP3A4 inhibitor compared to no inhibitor (adjusted HR 1.26, 95% CI 0.57\u20132.75,\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.569). These results suggest that concomitant use of a CYP2C19 inhibitor, but not a CYP3A4 inhibitor, may contribute to phenoconversion and decreased clopidogrel clinical effectiveness after PCI in\n                    <jats:italic>CYP2C19<\/jats:italic>\n                    genotype\u2010predicted NM\/RM\/UMs.\n                  <\/jats:p>","DOI":"10.1002\/cpt.70338","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T12:54:31Z","timestamp":1778849671000},"page":"531-541","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of\n                    <scp>CYP2C19<\/scp>\n                    and\n                    <scp>CYP3A4<\/scp>\n                    Inhibitor Use on Clopidogrel Clinical Effectiveness in\n                    <i>CYP2C19<\/i>\n                    Genotyped Patients Undergoing Percutaneous Coronary Intervention"],"prefix":"10.1002","volume":"120","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-4737-4239","authenticated-orcid":false,"given":"Danwei","family":"Shao","sequence":"first","affiliation":[{"name":"Division of Pharmacotherapy and Experimental Therapeutics Eshelman School of Pharmacy, University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6240-4876","authenticated-orcid":false,"given":"Jean G.","family":"Malav\u00e9","sequence":"additional","affiliation":[{"name":"Department of Pharmacotherapy &amp; Translational Research and Center for Pharmacogenomics and Precision Medicine, College of Pharmacy University of Florida  Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph S.","family":"Rossi","sequence":"additional","affiliation":[{"name":"Division of Cardiology and McAllister Heart Institute School of Medicine, University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8503-5736","authenticated-orcid":false,"given":"Francesco","family":"Franchi","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, College of Medicine\u2010Jacksonville University of Florida  Jacksonville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2915-4751","authenticated-orcid":false,"given":"Ellen C.","family":"Keeley","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, College of Medicine University of Florida  Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8451-2131","authenticated-orcid":false,"given":"Dominick J.","family":"Angiolillo","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, College of Medicine\u2010Jacksonville University of Florida  Jacksonville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George A.","family":"Stouffer","sequence":"additional","affiliation":[{"name":"Division of Cardiology and McAllister Heart Institute School of Medicine, University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7184-5292","authenticated-orcid":false,"given":"Larisa H.","family":"Cavallari","sequence":"additional","affiliation":[{"name":"Department of Pharmacotherapy &amp; Translational Research and Center for Pharmacogenomics and Precision Medicine, College of Pharmacy University of Florida  Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3595-5301","authenticated-orcid":false,"given":"Craig R.","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Pharmacotherapy and Experimental Therapeutics Eshelman School of Pharmacy, University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"},{"name":"Division of Cardiology and McAllister Heart Institute School of Medicine, University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,15]]},"reference":[{"key":"e_1_2_10_1_1","first-page":"e18","article-title":"ACC\/AHA\/SCAI guideline for coronary artery revascularization: a report of the American College of Cardiology\/American Heart Association joint committee on clinical practice guidelines","volume":"145","author":"Lawton J.S.","year":"2021","journal-title":"Circulation"},{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0706482"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0904327"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2018.0783"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1124\/dmd.109.029132"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40262-014-0230-6"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/tpj.2015.70"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.1543"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/cpt.2526"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001257"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/FPC.0000000000000547"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/fcp.12021"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.12.024"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1038\/clpt.2010.219"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/cpt.3712"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000112378.09325.F9"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.clpt.6100139"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/cpt.1099"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.15420\/ecr.2025.12"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.12441"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/cpt.3378"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/cpt.889"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/cpt.1768"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/cpt.2354"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1124\/jpet.115.225680"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00702-018-1922-0"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2023.1201906"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/cpt.2612"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.c.31390"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCGEN.118.002258"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12967-018-1469-8"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2017.07.022"},{"key":"e_1_2_10_33_1","unstructured":"For Healthcare Professionals | FDA's Examples of Drugs that Interact with CYP Enzymes and Transporter Systems<https:\/\/www.fda.gov\/drugs\/drug\u2010interactions\u2010labeling\/healthcare\u2010professionals\u2010fdas\u2010examples\u2010drugs\u2010interact\u2010cyp\u2010enzymes\u2010and\u2010transporter\u2010systems>. 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