Prescribing Proton Pump Inhibitor and Clopidogrel Together

Current State of Recommendations

Neena S. Abraham

Disclosures

Curr Opin Gastroenterol. 2011;27(6):558-564. 

In This Article

Does the Choice of Proton Pump Inhibitor Matter?

Pharmacokinetic and pharmacodynamic studies have suggested a differential response between various PPIs and clopidogrel;[30•,49] however, these data are inconsistent;[3••,50,51] and other factors such as diabetes, body mass index, smoking status, and renal insufficiency may also contribute to impaired clopidogrel activity independent of the co-prescription of a PPI.[3••,49] The PPI most commonly implicated as potentially harmful is omeprazole. The frequency of PPI gastroprotection is estimated to range from 31 to 64%[52–54] in major cardiovascular trials and national estimates from the Department of Veterans Affairs; omeprazole is the predominant PPI used in these studies, accounting for 37–60% of PPI co-prescription. No increase in cardiovascular events was observed in these major trials or observational studies – findings consistent with the reassuring observations of the COGENT trial. However, for providers who remain concerned about a potential interaction between omeprazole and clopidogrel, it might be prudent to co-prescribe an alternative PPI for high-risk individuals – those with a history of gastrointestinal bleeding,[55] the elderly[56–59] and those who are H. pylori positive;[60–62] and patients concomitantly prescribed steroids, selective serotonin re-uptake inhibitors (SSRIs) and warfarin.[18,59,63–66]

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