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clopidogrel proton pump

Meghan MacKenzie, Richard Hall
PURPOSE: Knowledge of how alterations in pharmacogenomics and pharmacogenetics may affect drug therapy in the intensive care unit (ICU) has received little study. We review the clinically relevant application of pharmacogenetics and pharmacogenomics to drugs and conditions encountered in the ICU. SOURCE: We selected relevant literature to illustrate the important concepts contained within. PRINCIPAL FINDINGS: Two main approaches have been used to identify genetic abnormalities - the candidate gene approach and the genome-wide approach...
October 17, 2016: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Timothy Nguyen, Roza Gavrilova, Marina Blazhko
Older adults frequently have multiple medical conditions and consequently receive multiple medications. Cardiovascular (CV) and gastrointestinal disorders are two conditions in seniors that often require both long-term antiplatelet therapy and medications for GI prophylaxis. Clopidogrel and pantoprazole are commonly used for these conditions; however, there are potential adverse consequences secondary to drug interactions. Both of these drugs are metabolized via the cytochrome P450 system, and there is a potential for drug interactions that may result in decreased effectiveness of clopidogrel and an increased risk of adverse CV outcomes...
2016: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
Iftikhar Ahmad Asim Syed, Syed Hasan Abbas Naqvi
Proton pump inhibitors are most widely prescribed medicines all over the world. Since their introduction in pharmacy, life of millions of people has changed completely. Their ability to inhibit acid secretion in stomach has changed the natural history of many once-dreaded conditions like peptic ulcer and gastroesophageal reflux disease. Operation like gastrectomy and partial gastrectomy are carried out very rarely. These medicines are considered very cost-effective, have excellent safety profile, and provide prompt symptomatic relief...
October 2016: JPMA. the Journal of the Pakistan Medical Association
S T Feng, Y Yan, J Y Fan, X Wang, W Zheng, S P Nie, Sergio Raposeiras-Roubín, Emad Abu-Assi, Jose P Simao Henriques, Fabrizio D Ascenzo, Jorge Saucedo, José R González-Juanatey, Stephen B Wilton, Wouter J Kikkert, Iván Nuñez-Gil, Albert Ariza-Sole, Dimitrios Alexopoulos, Christoph Liebetrau, Tetsuma Kawaji, Claudio Moretti, Zenon Huczek, Toshiharu Fujii, Luis C Correia, Masa-Aki Kawashiri, Sasko Kedev
Objective: The study aimed to analyze the impact of concomitant administration of P2Y12 inhibitors and PPIs on ischemia events in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). Methods: We retrospectively analyzed data from a international, multi-center registry between 2003 and 2014 in patients with ACS after PCI, grouped the cohort into patients receiving PPIs or no PPIs and assessed 1-year clinical endpoint (all-cause death/re-infarction). Meanwhile, we grouped the cohort into patients receiving clopidogrel or ticagrelor, and compared the impact of concomitant administration of PPIs and clopidogrel or ticagrelor on 1-year clinical endpoint...
September 6, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Jaya Chandrasekhar, Sameer Bansilal, Usman Baber, Samantha Sartori, Melissa Aquino, Serdar Farhan, Birgit Vogel, Michela Faggioni, Gennaro Giustino, Cono Ariti, Antonio Colombo, Alaide Chieffo, Annapoorna Kini, Richard Saporito, C Michael Gibson, Bernhard Witzenbichler, David Cohen, David Moliterno, Thomas Stuckey, Timothy Henry, Stuart Pocock, George Dangas, P Gabriel Steg, Roxana Mehran
BACKGROUND: Proton pump inhibitors (PPI) may decrease the availability of clopidogrel by competitive antagonism, leading to a potential increase in ischemic events. METHODS: We evaluated patients from the all-comer PARIS registry treated with dual antiplatelet therapy (DAPT) with aspirin and clopidogrel following coronary stenting for outcomes stratified by PPI use. Two-year major adverse cardiovascular events (MACE), composite of cardiac death, myocardial infarction, definite or probable stent thrombosis or target lesion revascularization (TLR), and net adverse cardiac events (NACE), composite of MACE or Bleeding Academic Research consortium (BARC) type 3 or 5 bleeding were assessed...
September 21, 2016: Catheterization and Cardiovascular Interventions
Xingyang Yi, Zhao Han, Qiang Zhou, Wen Cheng, Jing Lin, Chun Wang
OBJECTIVE: Conflicting data exist as to whether proton-pump inhibitors (PPIs) diminish the efficacy of clopidogrel. The aim of this study was to investigate the association between cytochrome P450 (CYP) genetic variants and clinical adverse outcomes of concomitant use of PPIs and clopidogrel by patients. METHODS: We consecutively enrolled 523 patients with ischemic stroke receiving clopidogrel. Platelet aggregation was measured before and after 7 to 10 days of clopidogrel treatment...
September 16, 2016: Clinical and Applied Thrombosis/hemostasis
Morten Würtz, Erik L Grove
Aspirin and P2Y12 receptor antagonists are widely used across the spectrum of cardiovascular diseases. Upper gastrointestinal complications, including ulcer and bleeding, are relatively common during antiplatelet treatment and, therefore, concomitant proton pump inhibitor (PPI) treatment is often prescribed.PPIs provide gastroprotection by changing the intragastric milieu, essentially by raising intragastric pH. In recent years, it has been heavily discussed whether PPIs may reduce the cardiovascular protection by aspirin and, even more so, clopidogrel...
September 15, 2016: Advances in Experimental Medicine and Biology
Xingyang Yi, Qiang Zhou, Chun Wang, Jing Lin, Wen Cheng, Lifen Chi
BACKGROUND AND PURPOSE: Conflicting data exist as to whether proton pump inhibitors (PPIs) diminish the efficacy of clopidogrel. We, therefore, assessed the effect of concomitant PPI use in ischemic stroke (IS) patients receiving clopidogrel. METHODS: We consecutively enrolled 535 IS patients receiving clopidogrel, 166 of whom were concomitantly taking PPIs. Platelet aggregation was measured before and after 7-10 days of treatment with clopidogrel. Single nucleotide polymorphisms of CYP3A4, CYP3A5, CYP2C19*2, and CYP2C19*3 were examined...
August 18, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Laura A Fortuna, Pamala A Pawloski, Emily D Parker, Nicole K Trower, Thomas E Kottke
AIMS: Daily low-dose aspirin is recommended for prevention of cardiovascular events in patients with coronary artery disease (CAD), and proton pump inhibitors (PPIs) are recommended to prevent or treat aspirin-associated gastrointestinal injury. Previous studies have reported contradictory findings regarding the risk of major adverse cardiovascular events (MACE) in patients who use PPI with aspirin therapy. We sought to examine associations between PPI use and MACE and all-cause mortality in aspirin-treated CAD patients...
January 2016: European Heart Journal. Cardiovascular Pharmacotherapy
Qiang Niu, Zhongsu Wang, Yong Zhang, Jiangrong Wang, Pei Zhang, Cong Wang, Xiangcui Yin, Yinglong Hou
BACKGROUND: Published data indicated that combination use of clopidogrel and proton pump inhibitors (PPIs) may increase the incidence of major adverse cardiovascular events (MACEs). This has been a highly controversial topic for years. DESIGN: The present study was performed to evaluate whether combination therapy of clopidogrel and PPIs is associated with increased risk of MACEs than with clopidogrel alone in patients with coronary artery disease. METHODS: A systematic search of MEDLINE, EMBASE, and the Cochrane Library was conducted for studies recording the occurrence of MACEs in patients with exposure to concomitant use of clopidogrel and PPIs up to February 2015...
August 10, 2016: Journal of Cardiovascular Pharmacology and Therapeutics
Luis A García Rodríguez, Mar Martín-Pérez, Charles H Hennekens, Peter M Rothwell, Angel Lanas
BACKGROUND: Low-dose aspirin has proven effectiveness in secondary and primary prevention of cardiovascular events, but is also associated with an increased risk of major bleeding events. For primary prevention, this absolute risk must be carefully weighed against the benefits of aspirin; such assessments are currently limited by a lack of data from general populations. METHODS: Systematic searches of Medline and Embase were conducted to identify observational studies published between 1946 and 4 March 2015 that reported the risks of gastrointestinal (GI) bleeding or intracranial hemorrhage (ICH) with long-term, low-dose aspirin (75-325 mg/day)...
2016: PloS One
Hong Sun, Xiao-Ya Lou, Xiao-Ying Wu, Huan Wang, Qiang Qu, Shen-Lan Tan, Jun-Shan Ruan, Jian Qu, Hui Chen
BACKGROUND: Cytochrome P450 2C19 (CYP2C19) is an important drug-metabolizing enzyme (DME), which is responsible for the biotransformation of several kinds of drugs such as proton pump inhibitors, platelet aggregation inhibitors and antidepressants. Previous studies showed that Buchang NaoXinTong capsules (NXT) increased the CYP2C19 metabolic activity in vitro and enhanced the antiplatelet effect of clopidogrel in vivo. However, the underlying molecular mechanism remained unclear. In the present study, we examined whether Pregnane X receptor (PXR) plays a role in NXT-mediated regulation of CYP2C19 expression...
2016: PloS One
Michael A Serbin, Gregory F Guzauskas, David L Veenstra
BACKGROUND: Uncertainty regarding clopidogrel effectiveness attenuation because of a drug-drug interaction with proton pump inhibitors (PPI) has led to conflicting guidelines on concomitant therapy. In particular, the effect of this interaction in patients who undergo a percutaneous coronary intervention (PCI), a population known to have increased risk of adverse cardiovascular events, has not been systematically evaluated. OBJECTIVE: To synthesize the evidence of the effect of clopidogrel-PPI drug interaction on adverse cardiovascular outcomes in a PCI patient population...
August 2016: Journal of Managed Care & Specialty Pharmacy
Nathalie Vernaz, Victoria Rollason, Liene Adlere, Christophe Combescure, Antoine Poncet, Pascal Bonnabry, Jules Desmeules
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...
June 2016: Pharmacology Research & Perspectives
Tomáš Bolek, Matej Samoš, Radoslava Šimonová, František Kovář, Marián Fedor, Peter Galajda, Ján Staško, Peter Kubisz, Marián Mokáň
BACKGROUND: Proton pump inhibition (PPI) administrated together with adenosine diphosphate (ADP) receptor blockers (ADPRB) significantly reduces the risk of gastrointestinal bleeding. Nevertheless, there is a heated discussion about an interaction between PPI and ADPRB that leads to high on-treatment platelet reactivity (HTPR). STUDY QUESTION: Is there a relationship between pantoprazole PPI and HTPR on ADPRB therapy in patients with acute ST-elevation myocardial infarction (STEMI)...
July 12, 2016: American Journal of Therapeutics
Remo Holanda de Mendonça Furtado, Robert Patrick Giugliano, Celia Maria Cassaro Strunz, Cyrillo Cavalheiro Filho, José Antonio Franchini Ramires, Roberto Kalil Filho, Pedro Alves Lemos Neto, Alexandre Costa Pereira, Tânia Rúbia Rocha, Beatriz Tonon Freire, Elbio Antonio D'Amico, José Carlos Nicolau
BACKGROUND: Proton-pump inhibitors (PPIs) are often prescribed to patients receiving dual antiplatelet therapy (DAPT). However, this class of medication, especially omeprazole, has been associated with a reduction in clopidogrel efficacy, leading many clinicians to substitute omeprazole with ranitidine. OBJECTIVES: Our objective was to compare the antiplatelet effect of clopidogrel before and after the addition of omeprazole or ranitidine. METHODS: We measured platelet aggregability at baseline and after 1 week of clopidogrel 75 mg daily...
August 2016: American Journal of Cardiovascular Drugs: Drugs, Devices, and Other Interventions
Muthiah Vaduganathan, Christopher P Cannon, Byron L Cryer, Yuyin Liu, Wen-Hua Hsieh, Gheorghe Doros, Marc Cohen, Angel Lanas, Thomas J Schnitzer, Thomas L Shook, Pablo Lapuerta, Mark A Goldsmith, Loren Laine, Deepak L Bhatt
BACKGROUND: Proton-pump inhibitors (PPIs) have been demonstrated to reduce rates of gastrointestinal events in patients requiring dual antiplatelet therapy (DAPT). Data are limited regarding the efficacy and safety of PPIs in high-risk cardiovascular subsets after acute coronary syndrome or percutaneous coronary intervention. METHODS: All patients enrolled in COGENT (Clopidogrel and the Optimization of Gastrointestinal Events Trial) were initiated on DAPT (with aspirin and clopidogrel) for various indications within the prior 21 days...
September 2016: American Journal of Medicine
Jen-Kuang Lee, Cho-Kai Wu, Jyh-Ming Juang, Chia-Ti Tsai, Juey-Jen Hwang, Jiuun-Lee Lin, Fu-Tien Chiang
BACKGROUND: The phenomenon of CYP2C19 polymorphism affects the metabolism of both clopidogrel and proton-pump inhibitors (PPI). However, concomitant use of both drugs may reduce the desired therapeutic effects. In this study, we evaluated whether individuals with different numbers of reduced-function CYP2C19 alleles were equally affected and whether PPIs with different dependencies on CYP2C19 metabolism were equally involved. METHODS: Thirty healthy volunteers were recruited to a six-week regimen of clopidogrel...
March 2016: Acta Cardiol Sin
Elias Karlsson, Manne Holm, Jan A van der Linden
Platelet inhibition during treatment with the antiplatelet drug clopidogrel is prone to great interindividual variability and is believed to be affected by several factors such as genetics and drug-drug interactions. Proton pump inhibitors have been shown to interfere with the liver metabolism of clopidogrel. However, there are limited data on any direct effects proton pump inhibitors may have on clopidogrel. The aim of the study was to evaluate whether the in vitro addition of pantoprazole affects platelet aggregation in blood samples from clopidogrel and aspirin-treated patients...
September 2016: Journal of Cardiovascular Pharmacology
Yan Yan, Xiao Wang, Jing-Yao Fan, Shao-Ping Nie, Sergio Raposeiras-Roubín, Emad Abu-Assi, Jose P Simao Henriques, Fabrizio D'Ascenzo, Jorge Saucedo, José R González-Juanatey, Stephen B Wilton, Wouter J Kikkert, Iván Nuñez-Gil, Albert Ariza-Sole, Xian-Tao Song, Dimitrios Alexopoulos, Christoph Liebetrau, Tetsuma Kawaji, Claudio Moretti, Zenon Huczek, Toshiharu Fujii, Luis C Correia, Masa-Aki Kawashiri, Sasko Kedev
BACKGROUND: There is great debate on the possible adverse interaction between proton pump inhibitors (PPIs) and clopidogrel. In addition, whether the use of PPIs affects the clinical efficacy of ticagrelor remains less known. We aimed to determine the impact of concomitant administration of PPIs and clopidogrel or ticagrelor on clinical outcomes in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). METHODS: We retrospectively analyzed data from a "real world", international, multi-center registry between 2003 and 2014 (n = 15,401) and assessed the impact of concomitant administration of PPIs and clopidogrel or ticagrelor on 1-year composite primary endpoint (all-cause death, re-infarction, or severe bleeding) in patients with ACS after PCI...
March 2016: Journal of Geriatric Cardiology: JGC
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