Table 1

Dutch Pharmacogenetics Working Group recommendations for the prescription of clopidogrel depending on phenotype.17

PhenotypeRecommendation
Ultrarapid metaboliserNo action is required for this gene–drug interaction
Intermediate metaboliserPercutaneous coronary intervention, stroke or TIA:
Choose an alternative or double the dose to 150 mg/day (600 mg loading dose)
Prasugrel, ticagrelor and acetylsalicylic acid/dipyridamole are not metabolised by CYP2C19 (or to a lesser extent).
Other indications:
No action required
Poor metaboliserPercutaneous coronary intervention, stroke or TIA:
Avoid clopidogrel
Prasugrel, ticagrelor and acetylsalicylic acid/dipyridamole are not metabolised by CYP2C19 (or to a lesser extent). Other indications:

  1. Determine the level of inhibition of platelet aggregation by clopidogrel.

  2. Consider an alternative in poor responders.


Prasugrel and ticagrelor are not metabolised by CYP2C19 (or to a lesser extent)

  • This table was obtained under Creative Commons Attribution 4.04 International (CC BY 4.0). Reprinted from: Royal Dutch Pharmacists Association. Pharmacogenetic Guidelines (Internet). Netherlands. Clopidogrel—CYP2C19 (cited 1 February 2022). Available from: https://www.knmp.nl/dossiers/farmacogenetica

  • TIA, transient ischaemic attack.