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Update on Plavix and Ulcer Drug Interaction

Friday, October 29, 2010 // Uncategorized

2/3/2009 12:00:00 AM

Plavix is a drug commonly used to thin the blood after heart attacks or stent placement.  It can increase the risk of bleeding, especially from the gastrointestinal tract.  For that reason it is often used in conjunction with PPI’s or proton pump inhibitors.  These include: Prilosec, Prevacid, Aciphex,Nexium and Protonix.  As it turns out, some of these drugs reduce the efficacy of Plavix.  In a study published in Canada yesterday.  There were significantly more heart attacks on people who used the combination with the exception of Protonix.

PPIs inhibit clopidogrel’s effect, study finds

In patients who have had an acute myocardial infarction, proton-pump inhibitors (PPIs) can inhibit the beneficial effects of clopidogrel and raise the risk of reinfarction, according to a new study. The results have led study authors as well as the FDA to recommend that clinicians re-evaluate the use of PPIs in patients taking clopidogrel.

The population-based, case-control study included 13,000 patients who were prescribed clopidogrel after an MI, 734 of whom were readmitted with MI within 90 days of discharge. After multivariable adjustment, current use of a PPI increased the risk of reinfarction by 27%. This increased risk was not present for the PPI pantoprazole, which has not been found to inhibit the bioactivation of clopidogrel, as the other drugs do.

Study authors estimated that between 5% and 15% of rapid readmissions in MI patients on clopidogrel may be caused by the drug interaction. They suggested that thousands of recurrent MIs could be prevented each year by using pantoprazole instead of omeprazole, lansoprazole or rabeprazole in patients taking clopidogrel. Ranitidine or another H2-receptor agonist may be another appropriate alternative, the authors said. The study was published online in the Canadian Medical Association Journal on Jan. 28.

The FDA last week announced plans to collaborate with the manufacturer of clopidogrel on research to understand the effects of genetic factors and other drugs, especially PPIs, on the effectiveness of clopidogrel. In the meantime, the agency recommended that healthcare providers and patients maintain clopidogrel therapy, but assess the use of PPIs, including Prilosec OTC, in patients taking clopidogrel.

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