Proton Pump Inhibitor and Clopidogrel Interaction: Fact or Fiction?

摘要: Current consensus recommendations state that patients prescribed clopidogrel plus aspirin should receive a proton pump inhibitor (PPI) to reduce gastrointestinal bleeding. Clopidogrel is converted its active metabolite by cytochrome P450 (CYP) enzymes. users with decreased CYP2C19 function have less inhibition of platelet aggregation and increased cardiovascular (CV) events. As PPI metabolism also involves CYP2C19, it was hypothesized competition PPIs might interfere clopidogrel's action. Omeprazole, but not other PPIs, worsens surrogate markers efficacy. Some (but all) observational studies show risks CV events (hazard/odds ratios=1.25-1.5). When effect sizes are small moderate (relative risks<1.5-2.0), however, only possible conclude whether statistical associations valid in randomized trials. A trial omeprazole vs. placebo showed no difference (hazard ratio=1.02,0.70-1.51). Thus, current evidence does justify conclusion associated among users, let alone judgment causality. Nonetheless, positive results from some biological plausibility led health-care providers accept The US Food Drug Administration (FDA) recommends "concomitant use drugs inhibit (e.g., omeprazole) be discouraged." the presence plasma short lived, separation 12-20 h theory prevent competitive CYP minimize any potential, though unproven, clinical interaction. may given before breakfast at bedtime, or taken dinner lunchtime.