Friday, November 20, 2009

Still more worries regarding clopidogel and PPIs

Previously on Retired Doc, I commented that first we were warned about a drug-drug interaction in which PPIs ( or at least omeprazole ) mitigated the therapeutic effect of clopidogrel in a clinically important way and then a randomized clinical may have failed to showed such a relationship.Now we need to worry again.

See here for comments about what the FDA is now saying about the combo of clopidogrel and omeprazole suggesting we need to dust of the H2 blockers rather than using the PPIs. Bad news for the PPIs but possibly good news for ticagrelor since it is, unlike clopidogrel, apparently not a prodrug and drug-drug interactions will be less likely.Then again look how long both Plavix and Prolosec were used before we had data sufficient to worry about that interaction.

1 comment:

Michael Kirsch, M.D. said...

Jack, since you are a 'retired doc', you have seen more of these studies that contradict each other every other year. I am a GI and prescribe quite a bit of PPI medicines. Is the interaction between PPIs and plavix a real phenomenon? I have no idea, but if past is prologue, then studies will soon appear refuting the interaction or, perhaps, demonstrating that PPIs will enhance plavix's potency. After 20 years of reading journals, I've learned that very few 'breaking news' medical studies stand the test of time. www.MDWhistleblower.blogspot.com