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Clopidogrel and PPI Interaction: Clinically Relevant or Not?

  • New Therapies for Cardiovascular Disease (KW Mahaffey, Section Editor)
  • Published:
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Abstract

Proton pump inhibitors and clopidogrel are commonly prescribed medications, both alone and in combination. In January of 2009 the US Food and Drug Administration and the European Medicines Agency issued warnings with regard to the concomitant use of clopidogrel and proton pump inhibitors. Later that year, these warnings were limited to the proton pump inhibitor omeprazole. These warnings were largely based on in-vitro studies and observational analyses suggesting decreased efficacy of clopidogrel in the presence of proton pump inhibitors. Recent literature has suggested there may not be a clinically meaningful interaction.

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Abbreviations

CAPRIE:

Clopidogrel Versus Aspirin in Patients at Risk of Ischaemic Events

CHARISMA:

Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance

CLARITY-TIMI 28:

Clopidogrel as Adjunctive Reperfusion Therapy-Thrombolysis in Myocardial Infarction 28

COGENT:

Clopidogrel and the Optimization of Gastrointestinal Events

CREDO:

Clopidogrel for the Reduction of Events During Observation

CURE:

Clopidogrel in Unstable Angina to Prevent Recurrent Events

MATCH:

Management of Atherothrombosis with Clopidogrel in High-Risk Patients with Recent Transient Ischemic Attacks or Ischemic Stroke

PLATO:

Platelet Inhibition and Patient Outcomes

PRINCIPLE TIMI-44:

Prasugrel in Comparison to Clopidogrel for Inhibition of Platelet Activation and Aggregation-Thrombolysis in Myocardial Infarction 44 Trial

TRITON TIMI-38:

Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel-Thrombolysis in Myocardial Infarction 38.

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Disclosure

Conflicts of interest: R.W. Harrison: none; K.W. Mahaffey: K.W. Mahaffey: has been a consultant for AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers, Squibb, Daiichi Sankyo, Eli Lilly, GlaxoSmithKline, Johnson & Johnson, Merck, Novartis, Ortho-McNeil, Pfizer, Polymedix, Sanofi-Aventis, and Schering-Plough; and has received grant support from AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers, Squibb, Daiichi Sankyo, Eli Lilly, GlaxoSmithKline, Johnson & Johnson, Merck, Novartis, Portola, Pozen, Regado Biotechnologies, Sanofi-Aventis, Schering-Plough, and The Medicines Company.

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Harrison, R.W., Mahaffey, K.W. Clopidogrel and PPI Interaction: Clinically Relevant or Not?. Curr Cardiol Rep 14, 49–58 (2012). https://doi.org/10.1007/s11886-011-0233-y

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