1) Interaction Effect: increased risk for thrombosis
2) Summary: The use of a proton pump inhibitor with clopidogrel may decrease the ability of clopidogrel to prevent acute myocardial events. In two studies, omeprazole significantly decreased the effect of clopidogrel on platelet inhibition.
Consider using a histamine-2 receptor antagonist in patients who require acid-lowering therapy
Severity: major Onset: delayed Substantiation: established
Probable Mechanism: decreased platelet inhibitory effect of clopidogrel by esomeprazole
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Although...there is some debate as to how serious of an interaction this is and whether it is a contraindication or just a "use with caution". My understanding is that the studes were all retrospective/observational so did not control for variables. Also, research does not support that the interaction occurs with PPIs other than Prilosec/Nexium. It is thought that Protonix is not as likely to have the interaction. I've read a lot about it in my ASHP listserve, many hospitals are writing notes in chart to ask if Dr would like to switch to Protonix or H2 antagonist, but some are waiting for more info. I have an review article coming my way on the subject.
ReplyDeleteAlso, (I forgot to mention) the FDA is mandating prospective trials be done by manufacturers before they make any official recommendations.
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