Document Detail

Proton pump inhibitors and clopidogrel: is it a significant drug interaction?
MedLine Citation:
PMID:  20377472     Owner:  NLM     Status:  MEDLINE    
IMPORTANCE OF THE FIELD: Clopidogrel is indicated as part of a dual antiplatelet therapy (DAT) with aspirin for the prevention of cardiac related events in acute coronary syndromes particularly in patients undergoing percutaneous coronary intervention. Recently, there have been reports of a clinically significant drug interaction between clopidogrel and proton pump inhibitors (PPI), which are frequently co-prescribed to prevent DAT associated gastrointestinal (GI) bleeding. AREAS COVERED IN THIS REVIEW: This review evaluates the risk of GI bleeding associated with DAT and the rationale for the use of PPI. This review also describes the pharmacokinetic and pharmacodynamic basis for the interaction and evaluates its significance on clinical outcomes. An extensive literature search on PubMed from January 1980 to August 2009 was performed. Additionally, abstracts and presentations from key cardiology meetings and press releases were reviewed for relevant studies related to the interaction. WHAT THE READER WILL GAIN: At the end of the review, readers should have a complete understanding of the interaction and steps that can be taken to limit the interaction. TAKE HOME MESSAGE: There is a mechanistic basis and pharmacodynamic data supporting an interaction between PPIs, particularly omeprazole and clopidogrel. The clinical significance of this interaction is, however, still a subject of intense debate and ongoing research.
Ola O Oyetayo; Robert L Talbert
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Expert opinion on drug safety     Volume:  9     ISSN:  1744-764X     ISO Abbreviation:  Expert Opin Drug Saf     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-06-17     Completed Date:  2010-09-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101163027     Medline TA:  Expert Opin Drug Saf     Country:  England    
Other Details:
Languages:  eng     Pagination:  593-602     Citation Subset:  IM    
University of Texas Health Science Center, Pharmacotherapy Education and Research Center, School of Medicine, 7703 Floyd Curl Drive, MC 6220, San Antonio, TX 78229, USA.
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MeSH Terms
Blood Platelets / drug effects
Drug Interactions
Drug Therapy, Combination / adverse effects
Gastrointestinal Agents / adverse effects
Gastrointestinal Hemorrhage / chemically induced,  prevention & control
Platelet Aggregation Inhibitors / adverse effects*,  metabolism,  therapeutic use
Proton Pump Inhibitors / adverse effects*,  metabolism,  therapeutic use
Randomized Controlled Trials as Topic
Ticlopidine / adverse effects,  analogs & derivatives*,  metabolism,  therapeutic use
Treatment Outcome
Reg. No./Substance:
0/Gastrointestinal Agents; 0/Platelet Aggregation Inhibitors; 0/Proton Pump Inhibitors; 55142-85-3/Ticlopidine; 90055-48-4/clopidogrel

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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