title: [Clopidogrel and proton pump inhibitors: insufficient evidence of interaction].
abstract: As both proton pump inhibitors (PPIs) and clopidogrel are metabolized by CYP2C19, an enzyme of the cytochrome P450 system, this could lead to drug competition. Recent studies have raised concerns that interaction of PPIs and clopidogrel could reduce the efficacy of clopidogrel and thus increase events such as myocardial infarction. This has resulted in opposing opinions and controversial recommendations. Optimal protection of patients at high risk for cardiovascular events is warranted. On the other hand, optimal gastroprotection for patients at risk for gastrointestinal bleeding is of clinical relevance. Despite the large number of studies, current evidence does not support the existence of an interaction between PPIs and clopidogrel. In agreement with international guidelines the approach of providing this combination therapy to those patients with an accepted indication for gastroprotection and secondary cardiovascular prevention is justified.
authors.affiliation: Apotheek Haagse Ziekenhuizen/HagaZiekenhuis, Ziekenhuisapotheek, Den Haag, the Netherlands. N.hunfeld@erasmusmc.nl
authors.forename: Nicole G M
authors.initials: NG
authors.lastname: Hunfeld
authors.forename: Vera E
authors.initials: VE
authors.lastname: Valkhoff
authors.forename: Daan J
authors.initials: DJ
authors.lastname: Touw
authors.forename: Miriam C J M
authors.initials: MC
authors.lastname: Sturkenboom
authors.forename: Ernst J
authors.initials: EJ
authors.lastname: Kuipers
mesh_terms: D001189:Aryl Hydrocarbon Hydroxylases / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000517:prevention & control; D000077144:Clopidogrel; D065731:Cytochrome P-450 CYP2C19; D003577:Cytochrome P-450 Enzyme System / Q000378:metabolism*; D004347:Drug Interactions; D005767:Gastrointestinal Diseases / Q000139:chemically induced / Q000517:prevention & control; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000378:metabolism / Q000494:pharmacology; D054328:Proton Pump Inhibitors / Q000009:adverse effects / Q000378:metabolism* / Q000494:pharmacology; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000378:metabolism / Q000494:pharmacology
chemical_list: D010975:Platelet Aggregation Inhibitors; D054328:Proton Pump Inhibitors; D003577:Cytochrome P-450 Enzyme System; D000077144:Clopidogrel; D001189:Aryl Hydrocarbon Hydroxylases; C045793:CYP2C19 protein, human; D065731:Cytochrome P-450 CYP2C19; D013988:Ticlopidine