Effects of the proton pump inhibitor lansoprazole on the pharmacokinetics and pharmacodynamics of prasugrel and clopidogrel.
Prasugrel and clopidogrel, thienopyridine prodrugs, are each metabolized to an active metabolite that inhibits the platelet P2Y(12) ADP receptor. In this open-label, 4-period crossover study, the effects of the proton pump inhibitor lansoprazole on the pharmacokinetics and pharmacodynamics of prasugrel and clopidogrel were assessed in healthy subjects given single doses of prasugrel 60 mg and clopidogrel 300 mg with and without concurrent lansoprazole 30 mg qd. C(max) and AUC(0-tlast) of prasugrel's active metabolite, R-138727, and clopidogrel's inactive carboxylic acid metabolite, SR26334, were assessed. Inhibition of platelet aggregation (IPA) was measured by turbidimetric aggregometry 4 to 24 hours after each treatment. Lansoprazole (1) decreased R-138727 AUC(0-tlast) and C(max) by 13% and 29%, respectively, but did not affect IPA after the prasugrel dose, and (2) did not affect SR62334 exposure but tended to lower IPA after a clopidogrel dose. A retrospective tertile analysis showed in subjects with high IPA after a clopidogrel dose alone that lansoprazole decreased IPA, whereas IPA was unaffected in these same subjects after a prasugrel dose. The overall data suggest that a prasugrel dose adjustment is not likely warranted in an individual taking prasugrel with a proton pump inhibitor such as lansoprazole.
Small
David S
DS
Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center DC 0724, Indianapolis, IN 46285, USA. dsmall@lilly.com
Farid
Nagy A
NA
Payne
Christopher D
CD
Weerakkody
Govinda J
GJ
Li
Ying G
YG
Brandt
John T
JT
Salazar
Daniel E
DE
Winters
Kenneth J
KJ
D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000009:adverse effects / Q000494:pharmacology*; D000244:Adenosine Diphosphate / Q000097:blood; D000293:Adolescent; D000328:Adult; D000368:Aged; D019540:Area Under Curve; D001682:Biological Availability; D000077144:Clopidogrel; D018592:Cross-Over Studies; D004347:Drug Interactions; D005260:Female; D006801:Humans; D064747:Lansoprazole; D008297:Male; D008875:Middle Aged; D010879:Piperazines / Q000009:adverse effects / Q000493:pharmacokinetics*; D010974:Platelet Aggregation / Q000187:drug effects; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000493:pharmacokinetics*; D000068799:Prasugrel Hydrochloride; D054328:Proton Pump Inhibitors / Q000009:adverse effects / Q000494:pharmacology*; D013876:Thiophenes / Q000009:adverse effects / Q000493:pharmacokinetics*; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000493:pharmacokinetics
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D054328:Proton Pump Inhibitors; D013876:Thiophenes; D064747:Lansoprazole; D000244:Adenosine Diphosphate; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D013988:Ticlopidine