Clopidogrel and Proton Pump Inhibitors: Between a Rock and a Hard Place

Momary, Kathryn M.; Cavallari, Larisa H.

doi:10.1592/phco.30.8.762

Cited by 3 publications

(6 citation statements)

References 31 publications

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“…Careful risk-benefit assessment is required before prescribing PPIs for individual patients receiving dual antiplatelet therapy. More evidence from randomized controlled trials is needed to clarify this drug interaction dilemma 23. It should be noted that H 2 receptor blockers are not as effective as PPIs at preventing gastrointestinal ulcer in patients taking Clopidogrel, but are a reasonable alternative for those at low risk for gastrointestinal bleeding.…”

Section: Discussionmentioning

confidence: 99%

Drug-drug interactions and their predictors: results from Indian elderly inpatients

Kashyap

D’Cruz

Sachdev

et al. 2013

Pharmacy Practice (Internet)

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*Background: In view of the multiple co-morbidities, the elderly patients receiving drugs are prone to suffer with drug interactions since they receive a greater number of drugs. Objective: The study was undertaken to determine the prevalence of drug interactions, as well as their predictors. Method: The prescriptions of a total of 1510 inpatients were collected prospectively for 1.5 years from inpatients wards of public tertiary care teaching hospital. All the prescriptions were checked for drug interactions using the Micromedex® Drug-Reax database-2010 and Stockley's Drug Interactions. Regression analyses sought to determine predictors for the drug interaction. Results: The patients, with the average age of 67.2 ±0.2 years, were prescribed an average of 9.15 ±0.03 medications. It was found that out of 1510 prescriptions of inpatients, 126 (8.3%) prescriptions had one or more than one drug interaction. All the identified interactions were severe in nature. The top most interacting drugs were acetylsalicylic acid and anticoagulant (n=59). The second top most interacting drug combination was clopidogrel and proton pump inhibitors (n=51). The most commonly involved drugs in interactions were C (cardiovascular system) and A (alimentary tract and metabolism). Using multivariate binary logistic regression, multiple drugs (Odds Ratio=4.5; 95% Confidence Interval: -2.38 -9.47) and multiple diagnoses (Odds Ratio=2.6; were found to be significant predictors for drug interaction. Conclusion:The results of this study substantiate the occurrence of severe drug interactions among Indian elderly inpatients. In order to provide safer pharmaceutical care, the active involvement of clinical pharmacists is a potential option.

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Section: Discussionmentioning

confidence: 99%

Drug-drug interactions and their predictors: results from Indian elderly inpatients

Kashyap

D’Cruz

Sachdev

et al. 2013

Pharmacy Practice (Internet)

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“…Several studies analyzed the prevalence of PPI and clopidogrel coprescription, demonstrating that there is a wide range of coprescription rates (Juurlink et al. ; Momary and Cavallari ; Bhurke et al. ; Urtane et al.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies analyzed the prevalence of PPI and clopidogrel coprescription, demonstrating that there is a wide range of coprescription rates Momary and Cavallari 2010;Bhurke et al 2012;Urtane et al 2013). Juurlink et al (2009) found 20% of coprescriptions for 13,636 patients in Ontario, and Ho et al (2009) found a higher rate of 64% for all patients discharged from any Veteran Affairs hospitals with acute myocardial infarction or unstable angina.…”

Section: Discussionmentioning

confidence: 99%

“…; Fleury and Beney ; Furuta et al. ; Momary and Cavallari ). Moreover, there is still an uncertainty about whether the CYP2C19 inhibition by omeprazole is reversible or irreversible (Ferreiro et al.…”

Section: Introductionmentioning

confidence: 99%

“…This assumption is based on the short half-life of both clopidogrel and PPIs. Some authors recommend separating the administration of the two drugs by at least 4 h, ideally 12 h, whereas others clinicians claim that the separation of administration would not benefit the patient (O'Donoghue et al 2009;Fleury and Beney 2010;Furuta et al 2010;Momary and Cavallari 2010). Moreover, there is still an uncertainty about whether the CYP2C19 inhibition by omeprazole is reversible or irreversible (Ferreiro et al 2011).…”

Section: Introductionmentioning

confidence: 99%

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Snapshot of the prescribing practice for the clopidogrel and esomeprazole coprescription and cost evaluation of the application guidelines

Vernaz

Rollason

Adlere

et al. 2016

Pharmacology Res & Perspec

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The antiplatelet clopidogrel and the proton pump inhibitor esomeprazole demonstrate a pharmacokinetic interaction through CYP2C19 that could translate into clinical inefficacy of clopidogrel. No medical consensus as to their coprescription has been reached, and different guidelines are available. We evaluated the prescribing practices at the Geneva University Hospitals (HUG) by measuring whether the coprescription was staggered as suggested by experts. We estimated the financial impact of different implementation guidelines. We used the HUG electronic patient records to follow the physicians' prescriptions and the administration by nurses from January 2013 to April 2014. We performed a time series analysis to assess 15 years of proton pump inhibitors (PPIs) and antiplatelet drug use. “Extra costs” were calculated assuming that clopidogrel or esomeprazole would replace prasugrel or ticagrelor and pantoprazole or ranitidine, respectively. Only 10.8% of the patient medical orders for the clopidogrel and esomeprazole coprescription specified to stagger the administration, 12.6% specified a concomitant coprescription, and 76.6% had no clear information. A high rate of 49.6% of the nurses staggered the clopidogrel and esomeprazole coprescription when no clear information was given. We found a statistically significant decrease in clopidogrel use after the publication of the OCLA (Omeprazole–CLopidogrel–Aspirin) study and a significant increase in the trend of esomeprazole. Alternative treatments to avoid this interaction are cost ineffective or offer therapeutic options of lesser quality. We observed a high rate of 56.2% of the clopidogrel and esomeprazole coprescription in our hospital and can therefore not ignore the PK/PD interaction. The most common prescription practice was to not specify the time frame of administration, which was translated by nurses in 49.6% of the cases to a scheduled staggered coprescription of clopidogrel and esomeprazole. As long as no consensus has been reached, the medical orders time frame information should be mandatory to allow a clear and harmonious staggering strategy.

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Piperidine-Based Fused Biheterocycles

Vardanyan

2017

Piperidine-Based Drug Discovery

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Clopidogrel and Proton Pump Inhibitors: Between a Rock and a Hard Place

Cited by 3 publications

References 31 publications

Drug-drug interactions and their predictors: results from Indian elderly inpatients

Drug-drug interactions and their predictors: results from Indian elderly inpatients

Snapshot of the prescribing practice for the clopidogrel and esomeprazole coprescription and cost evaluation of the application guidelines

Piperidine-Based Fused Biheterocycles

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