Abstract
Proton pump inhibitors (PPIs) are recommended in patients with prior upper gastrointestinal bleeding and considered appropriate in patients with multiple other risk factors who require dual antiplatelet treatment (DAPT). During the past few years, however, concerns have been raised about the potential for PPIs, especially omeprazole, to decrease the efficacy of clopidogrel, and both the U.S. Food and Drug Administration (FDA) and European Medicines Agency (EMA) have issued warnings regarding the concomitant use of these medications. A review of the literature revealed that the pharmacodynamic studies support an interaction, whereas the clinical evidence, which is mainly based on nonrandomized, observational studies and secondary analyses of randomized trials, is conflicting. We conclude that PPIs should be prescribed together with DAPT for patients in whom they are recommended according to the guidelines and for patients with other indications. With respect to omeprazole, current evidence does not allow clear recommendations to be provided.
Keywords: Proton pump inhibitors, omeprazole, clopidogrel, CYP2C19, drug interactions.
Current Vascular Pharmacology
Title:The Clopidogrel-PPI Interaction: An Updated Mini-Review
Volume: 12 Issue: 5
Author(s): Jacob Juel, Manan Pareek and Svend Eggert Jensen
Affiliation:
Keywords: Proton pump inhibitors, omeprazole, clopidogrel, CYP2C19, drug interactions.
Abstract: Proton pump inhibitors (PPIs) are recommended in patients with prior upper gastrointestinal bleeding and considered appropriate in patients with multiple other risk factors who require dual antiplatelet treatment (DAPT). During the past few years, however, concerns have been raised about the potential for PPIs, especially omeprazole, to decrease the efficacy of clopidogrel, and both the U.S. Food and Drug Administration (FDA) and European Medicines Agency (EMA) have issued warnings regarding the concomitant use of these medications. A review of the literature revealed that the pharmacodynamic studies support an interaction, whereas the clinical evidence, which is mainly based on nonrandomized, observational studies and secondary analyses of randomized trials, is conflicting. We conclude that PPIs should be prescribed together with DAPT for patients in whom they are recommended according to the guidelines and for patients with other indications. With respect to omeprazole, current evidence does not allow clear recommendations to be provided.
Export Options
About this article
Cite this article as:
Juel Jacob, Pareek Manan and Jensen Eggert Svend, The Clopidogrel-PPI Interaction: An Updated Mini-Review, Current Vascular Pharmacology 2014; 12 (5) . https://dx.doi.org/10.2174/157016111205140926161509
DOI https://dx.doi.org/10.2174/157016111205140926161509 |
Print ISSN 1570-1611 |
Publisher Name Bentham Science Publisher |
Online ISSN 1875-6212 |
Call for Papers in Thematic Issues
Advancements in Arterial Stiffness: Novel Therapeutic Frontiers
Arterial stiffness, a hallmark of cardiovascular disease, poses significant challenges in contemporary healthcare. This thematic issue delves into the multifaceted landscape of arterial stiffness and explores cutting-edge therapeutic interventions aimed at mitigating its adverse effects. Within these pages, readers will find a comprehensive overview of the mechanisms underlying arterial stiffness, ...read more
TREATMENT OF CARDIOVASCULAR DISEASE IN CHRONIC AND END STAGE KIDNEY DISEASE
Cardiovascular disease still remains the leading cause of death in Chronic and End Stage Kidney Disease, accounting for more than half of all deaths in dialysis patients. During the past decade, research has been focused on novel therapeutic agents that might delay or even reverse cardiovascular disease and vascular calcification, ...read more
- Author Guidelines
- Graphical Abstracts
- Fabricating and Stating False Information
- Research Misconduct
- Post Publication Discussions and Corrections
- Publishing Ethics and Rectitude
- Increase Visibility of Your Article
- Archiving Policies
- Peer Review Workflow
- Order Your Article Before Print
- Promote Your Article
- Manuscript Transfer Facility
- Editorial Policies
- Allegations from Whistleblowers
- Announcements
Related Articles
-
Living Life to the Fullest: Early Integration of Palliative Care into the Lives of Children with Chronic Complex Conditions
Current Pediatric Reviews Advances in Liver-Directed Gene Therapy for Hepatocellular Carcinoma by Non-Viral Delivery Systems
Current Gene Therapy Mesenchymal Stem/Stromal Cells: A New "Cells as Drugs" Paradigm. Efficacy and Critical Aspects in Cell Therapy
Current Pharmaceutical Design DNA Methylation, An Epigenetic Mode of Gene Expression Regulation in Reproductive Science
Current Pharmaceutical Design Cardiac Amyloid - A Hidden Contributor to Cardiac Dysfunction Following Cardiac Surgery: Case Report and Literature Review
Current Cardiology Reviews Editorial [Hot Topic: Novel Pharmacological Therapies for Cardiac Hypertrophy and Heart Failure (Executive Guest Editor: Peter M. Kang)]
Current Pharmaceutical Design Resveratrol in Cancer: Cellular and Mitochondrial Consequences of Proton Transport Inhibition
Current Pharmaceutical Design Cardiovascular Complications in Diabetes: Lessons from Animal Models
Current Medicinal Chemistry An Old Drug with a New Purpose: Cardiovascular Actions of Acetaminophen (Paracetamol)
Current Drug Targets - Cardiovascular & Hematological Disorders Myostatin in the Pathophysiology of Skeletal Muscle
Current Genomics Insulin Resistance and the Renin-Angiotensin-Aldosterone System in Metabolic Syndrome and Obesity-Related Hypertension
Current Hypertension Reviews Prolyl Oligopeptidase: A Rising Star on the Stage of Neuroinflammation Research
CNS & Neurological Disorders - Drug Targets Mitochondrial Biogenesis: Regulation By Endogenous Gases During Inflammation and Organ Stress
Current Pharmaceutical Design Decreased Vascular Repair and Neovascularization with Ageing: Mechanisms and Clinical Relevance with an Emphasis on Hypoxia- Inducible Factor-1
Current Molecular Medicine Stress Echocardiography
Current Pharmaceutical Design Effect of Vitamin D<sub>3</sub> on Lifespan in Caenorhabditis elegans
Current Aging Science Chemoprevention with Phytonutrients and Microalgae Products in Chronic Inflammation and Colon Cancer
Current Pharmaceutical Design Mechanisms and Medical Management of Exercise Intolerance in Hypertrophic Cardiomyopathy
Current Pharmaceutical Design Reduction of Myocardial Ischemia-Reperfusion Injury with Pre- and Postconditioning: Molecular Mechanisms and Therapeutic Targets
Cardiovascular & Hematological Disorders-Drug Targets Development of Nucleic Acid Drugs for Neurological Disorders
Current Topics in Medicinal Chemistry