Clopidogrel and proton pump inhibitor (PPI) interaction: separate intake and a non-omeprazole PPI the solution?
<p>Abstract</p> <p>Background</p> <p>Dual therapy with aspirin and clopidogrel increases the risk of gastrointestinal bleeding. Therefore, co-therapy with a proton pump inhibitor (PPI) is recommended by most guidelines. However, there are warnings against combining PPIs...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2010-05-01
|
| Series: | European Journal of Medical Research |
| Subjects: | |
| Online Access: | http://www.eurjmedres.com/content/15/5/220 |
| _version_ | 1819034544336011264 |
|---|---|
| author | Kenngott S Olze R Kollmer M Bottheim H Laner A Holinski-Feder E Gross M |
| author_facet | Kenngott S Olze R Kollmer M Bottheim H Laner A Holinski-Feder E Gross M |
| author_sort | Kenngott S |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>Dual therapy with aspirin and clopidogrel increases the risk of gastrointestinal bleeding. Therefore, co-therapy with a proton pump inhibitor (PPI) is recommended by most guidelines. However, there are warnings against combining PPIs with clopidogrel because of their interactions with cytochrome P450 isoenzyme 2C19 (<it>CYP2C19</it>).</p> <p>Methods</p> <p>The effects of the combined or separate intake of 20 mg of omeprazole and 75 mg of clopidogrel on the clopidogrel-induced inhibition of platelet aggregation were measured in four healthy subjects whose <it>CYP2C19 </it>exon sequences were determined. The effects of co-therapy with 10 mg of rabeprazole were also examined.</p> <p>Results</p> <p>Two subjects showed the wild-type <it>CYP2C19 </it>sequence. The concurrent intake of omeprazole had no effect on clopidogrel-induced platelet inhibition in these subjects. Two subjects were heterozygous for the *2 allele, with predicted reduced <it>CYP2C19 </it>activity. One of them was a clopidogrel non-responder. In the second heterozygous subject, omeprazole co-therapy reduced the clopidogrel anti-platelet effect when taken simultaneously or separately. However, the simultaneous intake of rabeprazole did not reduce the clopidogrel effect.</p> <p>Conclusion</p> <p>The clopidogrel-PPI interaction does not seem to be a PPI class effect. Rabeprazole did not affect the clopidogrel effect in a subject with a clear omeprazole-clopidogrel interaction. The separate intake of PPI and clopidogrel may not be sufficient to prevent their interaction.</p> |
| first_indexed | 2024-12-21T07:35:25Z |
| format | Article |
| id | doaj.art-7fd41ce5363c49ba9ff32708ab6eeef4 |
| institution | Directory Open Access Journal |
| issn | 2047-783X |
| language | English |
| last_indexed | 2024-12-21T07:35:25Z |
| publishDate | 2010-05-01 |
| publisher | BMC |
| record_format | Article |
| series | European Journal of Medical Research |
| spelling | doaj.art-7fd41ce5363c49ba9ff32708ab6eeef42022-12-21T19:11:29ZengBMCEuropean Journal of Medical Research2047-783X2010-05-0115522010.1186/2047-783X-15-5-220Clopidogrel and proton pump inhibitor (PPI) interaction: separate intake and a non-omeprazole PPI the solution?Kenngott SOlze RKollmer MBottheim HLaner AHolinski-Feder EGross M<p>Abstract</p> <p>Background</p> <p>Dual therapy with aspirin and clopidogrel increases the risk of gastrointestinal bleeding. Therefore, co-therapy with a proton pump inhibitor (PPI) is recommended by most guidelines. However, there are warnings against combining PPIs with clopidogrel because of their interactions with cytochrome P450 isoenzyme 2C19 (<it>CYP2C19</it>).</p> <p>Methods</p> <p>The effects of the combined or separate intake of 20 mg of omeprazole and 75 mg of clopidogrel on the clopidogrel-induced inhibition of platelet aggregation were measured in four healthy subjects whose <it>CYP2C19 </it>exon sequences were determined. The effects of co-therapy with 10 mg of rabeprazole were also examined.</p> <p>Results</p> <p>Two subjects showed the wild-type <it>CYP2C19 </it>sequence. The concurrent intake of omeprazole had no effect on clopidogrel-induced platelet inhibition in these subjects. Two subjects were heterozygous for the *2 allele, with predicted reduced <it>CYP2C19 </it>activity. One of them was a clopidogrel non-responder. In the second heterozygous subject, omeprazole co-therapy reduced the clopidogrel anti-platelet effect when taken simultaneously or separately. However, the simultaneous intake of rabeprazole did not reduce the clopidogrel effect.</p> <p>Conclusion</p> <p>The clopidogrel-PPI interaction does not seem to be a PPI class effect. Rabeprazole did not affect the clopidogrel effect in a subject with a clear omeprazole-clopidogrel interaction. The separate intake of PPI and clopidogrel may not be sufficient to prevent their interaction.</p>http://www.eurjmedres.com/content/15/5/220Proton Pump InhibitorsDrug InteractionsClopidogrelOmeprazoleRabeprazole |
| spellingShingle | Kenngott S Olze R Kollmer M Bottheim H Laner A Holinski-Feder E Gross M Clopidogrel and proton pump inhibitor (PPI) interaction: separate intake and a non-omeprazole PPI the solution? European Journal of Medical Research Proton Pump Inhibitors Drug Interactions Clopidogrel Omeprazole Rabeprazole |
| title | Clopidogrel and proton pump inhibitor (PPI) interaction: separate intake and a non-omeprazole PPI the solution? |
| title_full | Clopidogrel and proton pump inhibitor (PPI) interaction: separate intake and a non-omeprazole PPI the solution? |
| title_fullStr | Clopidogrel and proton pump inhibitor (PPI) interaction: separate intake and a non-omeprazole PPI the solution? |
| title_full_unstemmed | Clopidogrel and proton pump inhibitor (PPI) interaction: separate intake and a non-omeprazole PPI the solution? |
| title_short | Clopidogrel and proton pump inhibitor (PPI) interaction: separate intake and a non-omeprazole PPI the solution? |
| title_sort | clopidogrel and proton pump inhibitor ppi interaction separate intake and a non omeprazole ppi the solution |
| topic | Proton Pump Inhibitors Drug Interactions Clopidogrel Omeprazole Rabeprazole |
| url | http://www.eurjmedres.com/content/15/5/220 |
| work_keys_str_mv | AT kenngotts clopidogrelandprotonpumpinhibitorppiinteractionseparateintakeandanonomeprazoleppithesolution AT olzer clopidogrelandprotonpumpinhibitorppiinteractionseparateintakeandanonomeprazoleppithesolution AT kollmerm clopidogrelandprotonpumpinhibitorppiinteractionseparateintakeandanonomeprazoleppithesolution AT bottheimh clopidogrelandprotonpumpinhibitorppiinteractionseparateintakeandanonomeprazoleppithesolution AT lanera clopidogrelandprotonpumpinhibitorppiinteractionseparateintakeandanonomeprazoleppithesolution AT holinskifedere clopidogrelandprotonpumpinhibitorppiinteractionseparateintakeandanonomeprazoleppithesolution AT grossm clopidogrelandprotonpumpinhibitorppiinteractionseparateintakeandanonomeprazoleppithesolution |