title: East Asian perspective on the interaction between proton pump inhibitors and clopidogrel.
abstract: Both proton pump inhibitors (PPIs) and clopidogrel are widely prescribed in the Asia-Pacific population. PPIs are the mainstay therapeutic agents for prophylaxis against aspirin gastropathy and for acid-related disorders including gastroesophageal reflux disease. They are also co-prescribed with oral anticoagulant agents and with dual-antiplatelet therapy for the treatment and prevention of gastrointestinal bleeding. Clopidogrel belongs to the drug class of thienopyridines and is currently the most widely prescribed oral anticoagulant agent either alone or in combination with aspirin. Platelet inhibition by clopidogrel is prone to significant inter-individual variability and is believed to be affected by several factors such as genetics and drug-drug interactions. Since it was first reported in 2009, the potential for drug-drug interactions between PPIs and clopidogrel has remained headline news, and its significance in clinical practice is the subject of an ongoing debate. For East Asian patients in particular, the clinical relevance of the interaction between PPIs and clopidogrel remains unclear because of conflicting data, as well as underrepresentation of East Asian subjects in landmark trials. Increased CYP2C19 genetic polymorphisms in individuals from Asia-Pacific countries only fuel the confusion. Recent studies in East Asian cohorts suggests that the potential of PPIs to attenuate the efficacy of clopidogrel could be minimized by the use of newer PPIs with weaker affinity for the CYP2C19 isoenzyme, namely, pantoprazole, dexlansoprazole, and rabeprazole. This review aims to help clinicians choose the most appropriate PPI for co-prescription with clopidogrel in patients from Asia-Pacific countries.
authors.affiliation: Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Duowu
authors.initials: D
authors.lastname: Zou
authors.affiliation: Department of Gastroenterology and Hepatology, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Khean-Lee
authors.identifier: http://orcid.org/0000-0002-9965-1561
authors.initials: KL
authors.lastname: Goh
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000925:Anticoagulants / Q000008:administration & dosage; D044466:Asian People / Q000235:genetics; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects; D000077144:Clopidogrel; D065731:Cytochrome P-450 CYP2C19 / Q000235:genetics; D064748:Dexlansoprazole; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D005202:Asia, Eastern; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000517:prevention & control; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy / Q000517:prevention & control; D006801:Humans; D007527:Isoenzymes; D000077402:Pantoprazole; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D011110:Polymorphism, Genetic; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D064750:Rabeprazole; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000925:Anticoagulants; D007527:Isoenzymes; D010975:Platelet Aggregation Inhibitors; D054328:Proton Pump Inhibitors; D064750:Rabeprazole; D000077144:Clopidogrel; D000077402:Pantoprazole; D065731:Cytochrome P-450 CYP2C19; D013988:Ticlopidine; D001241:Aspirin; D064748:Dexlansoprazole
keywords: CYP2C19; East Asians; PPIs; Proton pump inhibitors; clopidogrel; drug-drug interactions