What question did this study set out to answer?

To evaluate the clinical and pharmacological interactions between the antiplatelet drug clopidogrel and proton pump inhibitors (PPIs).

May 26, 2009Annals of Pharmacotherapy

Drug–Drug Interaction Between Clopidogrel and the Proton Pump Inhibitors

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Why the study?

Does concomitant use of proton pump inhibitors reduce the antiplatelet effects of clopidogrel and increase adverse cardiovascular outcomes?

Population

Patients receiving clopidogrel therapy

Comparison

Concomitant use of proton pump inhibitors… vs Clopidogrel without PPIs or with alternative PPIs

Design

Review

Authors

NNNicholas B. NorgardUniversity of Missouri–Kansas City KMKathryn D. MathewsRoseman University of Health Sciences GWGeoffrey C. WallIowa Methodist Medical Center

Discussion

Member takes

Implication

May warrant avoiding omeprazole with clopidogrel; leaves open confirmation of cardiovascular outcomes in randomized trials.

Key Points

To evaluate the clinical and pharmacological interactions between the antiplatelet drug clopidogrel and proton pump inhibitors (PPIs).
Searched PubMed (1980–January 2009), cardiovascular conference abstracts (AHA 2008, SCAI 2009), and article reference lists using relevant search terms.
Identified and evaluated English-language original research and review articles focused on clopidogrel, PPIs, and CYP2C19 genetic polymorphisms.
Evidence indicates omeprazole competitively inhibits the CYP2C19 isoenzyme, significantly reducing clopidogrel's antiplatelet effects across laboratory testing.
Retrospective clinical analyses link concomitant PPI and clopidogrel therapy to increased adverse cardiovascular events, although pantoprazole demonstrates the lowest likelihood of interaction.

Structured PICO

Does concomitant use of proton pump inhibitors reduce the antiplatelet effects of clopidogrel and increase adverse cardiovascular outcomes?

Population

Patients receiving clopidogrel therapy

Intervention

Concomitant use of proton pump inhibitors (PPIs), specifically omeprazole

Comparator

Clopidogrel without PPIs or with alternative PPIs

Outcome

Antiplatelet effects of clopidogrel and adverse cardiovascular outcomes

Omeprazole appears to significantly reduce the antiplatelet efficacy of clopidogrel, suggesting pantoprazole should be preferred when concomitant PPI therapy is indicated.

Cite This Study

Norgard et al. (2009) studied this question.

synapsesocial.com/papers/6a7d0bc3ec6dad7f5aaa0745 https://doi.org/10.1345/aph.1m051

Topics

Dual antiplatelet therapy

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