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April 18, 2009 -- 10:45pm EDT

Plavix and PPIs: Update
A couple of months ago I wrote about the confusion surrounding the combination of Plavix and Proton Pump Inhibitors (PPIs) -- the FDA had just issued a statement that there was concern that PPIs may interfere with Plavix, the news media carried many stories warning of a potential risk, but the ACC, AHA and SCAI urged patients not to change their medications without consulting their cardiologists (Plavix is critical for stent patients in order to reduce the risk of stent thrombosis).

So earlier today reader D.B., a pharmacist in California, sent in this:

In fact, there are two recent updates.

One is a study in the current issue of Thrombosis and Haemostasis, an official publication from the European Society of Cardiology. The article, "Impact of proton pump inhibitors on the antiplatelet effects of clopidogrel", shows a definite effect in the inhibition of clopidogrel's antiplatelet function when using omeprazole (a.k.a. Prilosec) but, interestingly enough, the other PPIs tested showed no such effect. However, it was a study that measured platelet reactivity and not clinical results, so the other PPIs are still not out of the woods. In fact an editorial in the same issue recommends against the use of PPIs with Plavix (clopidogrel) which goes against the recommendations of the American societies.

The second update (or future update) may clear some of this up in a few weeks. New results from the Medco study are scheduled to be presented at the annual SCAI meeting in Las Vegas May 6-9, so we'll be reporting on that when it breaks. It will be interesting to see if guidelines and recommendations will change as a result.

As for H2 blockers (like Pepcid) they were by and large replaced when PPIs hit the market. There is question how effective they are in this situation, and they also had some side-effects, but were never shown to inhibit antiplatelet drugs like Plavix.

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