Proton pump inhibitor and clopidogrel interaction: the case for watchful waiting.
Clopidogrel is an integral part of the management of several important vascular diseases. However the medium to long term clinical outcomes are poorer for these patients if they experience gastro-intestinal bleeding, hence patients with risk factors for gastro-intestinal bleeding are frequently prescribed proton pump inhibitors. Conflicting evidence exists as to the existence of an adverse interaction between clopidogrel and proton pump. This review examines the original studies, which suggested the adverse interaction, the subsequent and most recent studies, the pharmaco-dynamics of the two drugs and suggests an algorithm for the use of clopidogrel with proton pump inhibitors.
Tan
Victoria P
VP
Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
Yan
Bryan P
BP
Hunt
Richard H
RH
Wong
Benjamin C Y
BC
D000465:Algorithms; D000077144:Clopidogrel; D004347:Drug Interactions; D019317:Evidence-Based Medicine; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000517:prevention & control*; D006801:Humans; D010974:Platelet Aggregation / Q000187:drug effects*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D017410:Practice Guidelines as Topic; D054328:Proton Pump Inhibitors / Q000009:adverse effects*; D018570:Risk Assessment; D012307:Risk Factors; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives*
D010975:Platelet Aggregation Inhibitors; D054328:Proton Pump Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine