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 Printable version |
Should the combination clopidogrel-proton pump inhibitor be avoided? |
 Résumé
Article gratuit
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Author(s) : Dominique Deplanque |
Summary : In a letter send at the end of October 2009, Sanofi-Aventis and Bristol-Myers Squibb, in accordance with both French and European authorities, informed clinicians about a possible decrease in anti-agregant efficacy of clopidogrel when associated with proton pump inhibitors. In the absence of complementary data, prescription of such a treatment combination should be avoided except absolute necessity. Clopidogrel is a pro-drug that should be metabolized by P450 2C19 cytochrome before to develop its anti-agregant effects. Proton pump inhibitors are also substrate of such enzyme and then may be responsible for a decrease in both clopidogrel metabolization and efficacy. While several studies based on platelet aggregation biomarkers seem to confirm these theoretical data, at least with omeprazole, studies about clinical impact of this combination remain inconsistent. Thus, retrospective data based on prescription registries seem to confirm an increased vascular risk in patients receiving such treatments while prospective randomized and controlled studies show no differences except an increased risk of intestinal bleeding in patients not receiving proton pump inhibitors. Waiting for complementary data, it is advisable to remain cautious without to deny patients proton pump inhibitors when it is necessary. |
Keywords : clopidogrel, proton pump inhibitors, interaction, pharmacokinetic |
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