title: P2Y12 Receptor Antagonists and Morphine: A Dangerous Liaison?
abstract: P2Y12 receptor antagonists, concurrently administered with aspirin in what has come to be commonly called dual antiplatelet therapy, are a mainstay of treatment for patients with acute coronary syndromes. Morphine, on the contrary, is a commonly used drug in the acute phase of acute coronary syndromes to relieve pain-with the added potential benefit of attenuating acutely raised sympathetic tone. In current guidelines, though, morphine is recommended with decreasing strength of recommendation. One reason is that it raises concern regarding the potentially significant interaction with antiplatelet agents, leading to impaired inhibition of platelet activation. In any case, it is still considered a mandatory part of the inventory of available medications in prehospital acute myocardial infarction management. The goal of the present review is to present published evidence on morphine and its potential interactions with P2Y12 receptor antagonists, as well as on the central issue of whether such interactions may underlie clinically significant effects on patient outcomes.
authors: From the Second Department of Cardiology, National and Kapodistrean University of Athens, Attikon University Hospital, Greece (G.G., S.D., F.K., J.L., D.A.); and Department of Cardiology, University of Patras, University Hospital of Rio, Greece (I.X.). ggiann@med.uoa.gr georgios.giannopolous@yale.edu.
authors: Georgios
authors: G
authors: Giannopoulos
authors: From the Second Department of Cardiology, National and Kapodistrean University of Athens, Attikon University Hospital, Greece (G.G., S.D., F.K., J.L., D.A.); and Department of Cardiology, University of Patras, University Hospital of Rio, Greece (I.X.).
authors: Spyridon
authors: S
authors: Deftereos
authors: From the Second Department of Cardiology, National and Kapodistrean University of Athens, Attikon University Hospital, Greece (G.G., S.D., F.K., J.L., D.A.); and Department of Cardiology, University of Patras, University Hospital of Rio, Greece (I.X.).
authors: Fotios
authors: F
authors: Kolokathis
authors: From the Second Department of Cardiology, National and Kapodistrean University of Athens, Attikon University Hospital, Greece (G.G., S.D., F.K., J.L., D.A.); and Department of Cardiology, University of Patras, University Hospital of Rio, Greece (I.X.).
authors: Ioanna
authors: I
authors: Xanthopoulou
authors: From the Second Department of Cardiology, National and Kapodistrean University of Athens, Attikon University Hospital, Greece (G.G., S.D., F.K., J.L., D.A.); and Department of Cardiology, University of Patras, University Hospital of Rio, Greece (I.X.).
authors: John
authors: J
authors: Lekakis
authors: From the Second Department of Cardiology, National and Kapodistrean University of Athens, Attikon University Hospital, Greece (G.G., S.D., F.K., J.L., D.A.); and Department of Cardiology, University of Patras, University Hospital of Rio, Greece (I.X.).
authors: Dimitrios
authors: D
authors: Alexopoulos
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects*; D000818:Animals; D001792:Blood Platelets / Q000187:drug effects* / Q000378:metabolism; D004347:Drug Interactions; D004351:Drug Resistance; D006801:Humans; D009020:Morphine / Q000009:adverse effects*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000493:pharmacokinetics; D058921:Purinergic P2Y Receptor Antagonists / Q000009:adverse effects* / Q000493:pharmacokinetics; D058925:Receptors, Purinergic P2Y12 / Q000097:blood / Q000187:drug effects*; D018570:Risk Assessment; D012307:Risk Factors; D015398:Signal Transduction / Q000187:drug effects; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; C548576:P2RY12 protein, human; D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D058925:Receptors, Purinergic P2Y12; D009020:Morphine
keywords: acute coronary syndrome; antiplatelet drug resistance; antiplatelet therapy; inhibition; interaction; opioid