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Cytochrome 2C19
• Plavix and Effient are pro drugs
• Plavix requires 2 passes through cytochrome 2C19
– Some meds (PPI) interfere with activation
– Genetic variation
• 18% of asians have 2C19 variation – reduced
effect
• Effient does not show clinical effect of 2C 19 variation
• Significance is that not all patients receive full effect of
Plavix