[Clopidogrel and proton pump inhibitors: insufficient evidence of interaction].

Abstract

As both proton pump inhibitors (PPIs) and clopidogrel are metabolized by CYP2C19, an enzyme of the cytochrome P450 system, this could lead to drug competition. Recent studies have raised concerns that interaction of PPIs and clopidogrel could reduce the efficacy of clopidogrel and thus increase events such as myocardial infarction. This has resulted in opposing opinions and controversial recommendations. Optimal protection of patients at high risk for cardiovascular events is warranted. On the other hand, optimal gastroprotection for patients at risk for gastrointestinal bleeding is of clinical relevance. Despite the large number of studies, current evidence does not support the existence of an interaction between PPIs and clopidogrel. In agreement with international guidelines the approach of providing this combination therapy to those patients with an accepted indication for gastroprotection and secondary cardiovascular prevention is justified.

• Authors: Nicole G M Hunfeld, Vera E Valkhoff, Daan J Touw, Miriam C J M Sturkenboom, Ernst J Kuipers
• Journal: Nederlands tijdschrift voor geneeskunde (Ned Tijdschr Geneeskd) Vol. 155 Issue 28 Pg. A2404 ( 2011) ISSN: 1876-8784 [Electronic] Netherlands
• Vernacular Title: Clopidogrel en protonpompremmers: onvoldoende bewijs van interactie.
• PMID: 21771376 (Publication Type: Journal Article)

Chemical References

• Platelet Aggregation Inhibitors
• Proton Pump Inhibitors
• Cytochrome P-450 Enzyme System
• Clopidogrel
• Aryl Hydrocarbon Hydroxylases
• CYP2C19 protein, human
• Cytochrome P-450 CYP2C19
• Ticlopidine

Topics

• Aryl Hydrocarbon Hydroxylases (metabolism)
• Cardiovascular Diseases (chemically induced, prevention & control)
• Clopidogrel
• Cytochrome P-450 CYP2C19
• Cytochrome P-450 Enzyme System (metabolism)
• Drug Interactions
• Gastrointestinal Diseases (chemically induced, prevention & control)
• Humans
• Platelet Aggregation Inhibitors (adverse effects, metabolism, pharmacology)
• Proton Pump Inhibitors (adverse effects, metabolism, pharmacology)
• Ticlopidine (adverse effects, analogs & derivatives, metabolism, pharmacology)