PPIs reduce the effectiveness of clopidogrel (Plavix)

clopidogrel_plavix

Pharmamotion has now a new page containing updates on  clopidogrel – PPI interactions.

The latest edition of the monthly newsletter from the Medicines and Healthcare products Regulatory Agency has issued a drug safety advice on the interaction between the antiplatelet drug clopidogrel (Plavix) and PPIs.

They conclude that available data supports a clinically significant interaction that makes clopidogrel less effective when given with these drugs.

Their advice for healthcare professionals:

    • The need for PPI therapy in patients who are also taking clopidogrel should be reviewed at their next appointment: avoid concomitant use of these medicines unless considered essential.

    • Prescribe PPIs in line with their licensed indications where possible.

    • Check whether patients who are taking clopidogrel are buying over-the-counter omeprazole and consider whether another gastrointestinal therapy would be more suitable.

The bottom line message is clear:

Concomitant use of a PPI with clopidogrel should be avoided unless considered essential.

Source: Drug Safety Update: Volume 2 Issue 12, July 2009

Further reading

Pezalla E, et al. Initial assessment of clinical impact of a drug interaction between clopidogrel and proton pump inhibitors. J Am Coll Cardiol 2008; 52: 1038.

Ho M, et al. Risk of adverse outcomes associated with concomitant use of clopidogrel and proton pump inhibitors following acute coronary syndrome. JAMA 2009; 301: 937.

Juurlink D, et al. A population-based study of the drug interaction between proton pump inhibitors and clopidogrel. CMAJ 2009; 180: 713–18.

Society for Cardiovascular Angiography and Interventions statement on “A national study of the effect of individual proton pump inhibitors on cardiovascular outcomes in patients treated with clopidogrel following coronary stenting: The Clopidogrel Medco Outcomes Study”.

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