Safe Use of Warfarin and Omeprazole

Benefits and Precautions

The American College of Cardiology recommends using proton pump inhibitors like omeprazole to reduce the risk of gastrointestinal bleeding in patients receiving ≥2 antithrombotic agents 1, 2
In patients at high risk of bleeding who are taking warfarin, the use of omeprazole may be especially beneficial as gastric protection 1, 2
For patients taking warfarin with a history of gastrointestinal bleeding, the use of a proton pump inhibitor like omeprazole is particularly indicated 2, 3
Other medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), can significantly increase the risk of bleeding when taken with warfarin 2
Patients should maintain a stable dose of omeprazol once treatment is initiated, as changes in dosage could theoretically affect INR stability 4
In rare cases of patients who are extensive metabolizers of CYP2C19, there could be a more pronounced interaction, but this is not clinically significant for most patients 4