Clopidogrel and the possibility of drug–drug interaction in primary health care

Urtane, Inga; Aitullina, Aleksandra; Pukite, Katrina

doi:10.1016/j.jyp.2013.01.002

Cited by 4 publications

(3 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The CCBs and Statins are used widely in cardiology, and the chance of their co-administration with clopidogrel is very high (Urtane et al, 2013). CCBs inhibit CYP3A4, interfere with the activation of clopidogrel (Siller-Matula et al, 2008).…”

Section: Discussionmentioning

confidence: 99%

Clopidogrel efficacy with concomitant drug therapy in patients undergoing percutaneous coronary intervention

Alsalloum¹,

Ibrahim²

2020

Int. j. adv. appl. sci.

View full text Add to dashboard Cite

Clopidogrel, as an adjunct to aspirin, has been recommended for patients undergoing percutaneous coronary intervention (PCI) to reduce adverse cardiovascular events. Clopidogrel needs activation via the cytochromes P450 enzymes. Concomitant use of clopidogrel with drugs that utilize the same enzymatic pathway may interfere with its conversion to an active form. This study aims to assess the impact of concomitant drug therapy on clopidogrel efficacy in patients undergoing PCI and to identify the association between the use of those drugs and the risk of future adverse cardiac events. A total of 126 medical records for patients followed at King Fahad Specialist Hospital, and King Saud Hospital in Qassim, Saudi Arabia, were reviewed. Patients were divided into six groups: First group clopidogrel, second to fourth group clopidogrel plus proton pump inhibitors (PPIs)/calcium channel blockers (CCBs)/statins, fifth group clopidogrel with either PPIs, CCBs, statins, and sixth group clopidogrel plus PPIs, CCBs, and statins. Descriptive statistics were performed to detect the correlation between the concomitant drug used and MACEs. Out of the total number, 58 patients had MACEs. The correlation between MACEs and medications used in the groups of clopidogrel with PPIs, statins, or combinations of PPIs with CCBs and statins, or combination of two drugs had a MACEs rate of 12% (P= 0.027), 17.2% (P= 0.0041), 19% (P= 0.0021), 43.1% (P= 0.0001) respectively in comparison to 3.45% in the clopidogrel group. Therefore, concomitant use of clopidogrel with PPIs, statins, or combinations of PPIs with CCBs and statins, or a combination of two drugs is associated with a higher risk of MACEs. This suggests that these medications may attenuate the antiplatelet effect clopidogrel. Prospective randomized studies are needed to provide firm evidence for this interaction.

show abstract

Section: Discussionmentioning

confidence: 99%

Clopidogrel efficacy with concomitant drug therapy in patients undergoing percutaneous coronary intervention

Alsalloum¹,

Ibrahim²

2020

Int. j. adv. appl. sci.

View full text Add to dashboard Cite

show abstract

“…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%

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

View full text Add to dashboard Cite

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.

show abstract

“…Drug interactions are influenced by many factors. Clopidogrel is metabolized through CYP450, a variety of isozymes are involved in this process, such as CYP1A2, CYP2C9, CYP2D6, and CYP3A5, 32 – 35 except the 2 most important CYP3A4 and CYP2C19. The combination of CYP3A4 and CYP2C19 inhibitors may be not sufficient to affect the metabolism of clopidogrel.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Clopidogrel and Clinical Outcome When Clopidogrel Is Coadministered With Atorvastatin and Lansoprazole

Zhang

Wang

et al. 2015

Medicine

View full text Add to dashboard Cite

This prospective, randomized, nonblind, controlled trial evaluated the effects of clopidogrel on platelet function upon coadministration with atorvastatin and lansoprazole.One hundred four adult patients with non-ST-segment elevated acute coronary syndrome (NSTE-ACS) who underwent percutaneous coronary intervention (PCI) with drug-eluting stent implantation were included. All patients were treated with standard dual antiplatelet therapy (DAPT) plus rosuvastatin 10 mg daily after the operation. On the sixth day after PCI, patients were randomly divided into 4 groups, Group A: DAPT + atorvastatin 20 mg daily (a change from rosuvastatin to atorvastatin) + lansoprazole 30 mg daily, Group B: DAPT + atorvastatin 20 mg daily (a change from rosuvastatin to atorvastatin), Group C: DAPT + lansoprazole 30 mg daily (continuing to take rosuvastatin), Group D is the control group. Additional drugs were used according to the situation of patients. Platelet function and concentrations of platelet activation markers (granular membrane protein 140 (P-selectin), thromboxane B2 (TXB2), and human soluble cluster of differentiation 40 ligand (sCD40L)) were assessed before randomization and at 15- and 30-day follow-up visits. All patients were maintained on treatment for 6 months and observed for bleeding and ischemic events.A total of 104 patients were enrolled, 27 patients in group A, 26 patients in Group B/C, 25 patients in Group D separately, and all the patients were analyzed. There were no differences in platelet function and the levels of platelet activation markers (P-selectin, TXB2, and sCD40L) among or within the 4 groups at the 3 time points of interest (P > 0.05). In the subsequent 6 months, no significant bleeding events occurred, and 12 patients experienced ischemic events, these results were also not significantly different among the groups (P > 0.05).In patients diagnosed with NSTE-ACS who have had drug-eluting stent implantation, simultaneously administering clopidogrel, atorvastatin, and lansoprazole did not decrease the antiplatelet efficacy of clopidogrel or increase adverse event frequency over 6 months.

show abstract

Clopidogrel and the possibility of drug–drug interaction in primary health care

Cited by 4 publications

References 23 publications

Clopidogrel efficacy with concomitant drug therapy in patients undergoing percutaneous coronary intervention

Clopidogrel efficacy with concomitant drug therapy in patients undergoing percutaneous coronary intervention

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

Efficacy of Clopidogrel and Clinical Outcome When Clopidogrel Is Coadministered With Atorvastatin and Lansoprazole

Contact Info

Product

Resources

About