Interactions between the use of clopidogrel and proton pump inhibitors

The  EU  Committee for Medicinal Products for Human Use (CHMP) has recently  considered  the  available  evidence  for an interaction between  clopidogrel  and  proton  pump  inhibitors  (PPIs).  They concluded  that  PPIs  reduce  the effectiveness of clopidogrel in preventing  the recurrence of adverse cardiac events such as heart attack  and  coronary artery restenosis (renarrowing of the artery wall  despite  past heart surgery). Further information, including a  series  of  questions  and  answers  for  patients, is provided below.  The  European  Medicines  Agency  (external link) has also recently  published  information  on this interaction. Information and  advice  for healthcare professionals is also published in the July    issue  of  Drug  Safety  Update  on  page  2.  Clopidogrel Clopidogrel    (brand    name    Plavix)    is   used  to  prevent atherothrombotic  events  (e.g.  a  heart  attack  or  stroke)  in patients  who  have  previously  had one of these life-threatening events,  or  in  at-risk  patients  who  have  peripheral arterial disease  (narrowing  of  the  arteries,  mainly  in  the legs). In combination   with  aspirin,  it  can  also  be  used  to  prevent atherothrombotic  events  in patients with acute coronary syndrome (a  serious  disorder with various clinical signs that suggest the heart  is  receiving  inadequate  oxygen).  PPIs  PPIs are used to treat  the  gastrointestinal disorders, oesophageal reflux disease (a   frequent  cause  of  indigestion  and  heartburn),  dyspepsia (indigestion)  or  gastric  ulcers.  In  the  UK,  five  PPIs  are available      on    prescription:    omeprazole,    esomeprazole, pantoprazole,  rabeprazole,  and  lansoprazole. Omeprazole is also available  over  the  counter  (Losec). Clopidogrel can cause side effects    on    the  gastrointestinal  system  and  is  therefore frequently  prescribed  together  with  a PPI. Interaction Several studies  have  found  that  the  use  of PPIs lowered the clinical effectiveness  of  clopidogrel  in  preventing  the  recurrence of atherothrombotic  events  in  patients  who  have previously had a serious  heart  condition (including coronary artery restenosis or heart attack).

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