Abstract

RISK OF CONCOMITANT USE OF PROTON PUMP INHIBITORS AND CLOPIDOGREL ON CLINICAL OUTCOMES IN PATIENTS WITH ACUTE CORONARY SYNDROME- A REVIEW

Nancy A. M.*, Sandip K. C., Sachin M. Mathews and Ashwin Krishna M.

ABSTRACT

The pathogenesis of Acute Coronary syndrome mainly include platelet activation and platelet aggregation. Hence the treatment of Acute Coronary Syndromes include various anti-platelet therapies. Proton Pump Inhibitors (PPI’s) are highly recommended for patients receiving treatment with clopidogrel as it reduces the risk of gastrointestinal tract bleeding .Numerous studies have been conducted to assess the effect of Proton Pump Inhibitors on Clopidogrel. However the results of these studies are conflicting and a definite answer is still awaited. AIM: This review aims at providing an overview of the evidence of the pharmacological interaction between clopidogrel and Proton Pump Inhibitors. RESULTS: Majority of the published studies on the topic show that there is significant interaction between proton pump inhibitors and clopidogrel. PPI’s pharmaco-dynamically reduce the effectiveness of clopidogrel. The studies also reflect that there has been a need for prolonged hospitalization or in some cases death of the patients a result of the interaction. 10 studies from over 10,000 patients were reviewed to derive evidence against the clinically important interaction. CONCLUSION: The review of the ten studies suggest that there is a plausible interaction between PPI’s and Clopidogrel. PPI’s reduces the effectiveness of clopidogrel and hence therapeutic drug monitoring maybe necessary to achieve the desired therapeutic effect. However no definite proof exists for the effect of the interaction on mortality. To reduce the adverse effect caused by the interaction combining clopidogrel with a less CYP2C19 may be considered.

Keywords: Drug interaction, Proton Pump Inhibitors (PPI’s), Clopidogrel, Acute Coronary Syndrome.