Plavix, PPI Combo: Risky for Heart Patients?
Study Shows Risks of Combining Plavix and Proton Pump Inhibitors
WebMD News Archive
PPIs Routinely Given With Plavix continued...
Taking Plavix with a PPI at any time during the follow-up was associated
with a 25% increase in risk for death or hospitalization.
American Heart Association president Timothy Gardner, MD, tells WebMD that
it is now clear that PPIs should be prescribed cautiously to heart patients
"If a patient has a history of GI bleeding, we know that [Plavix] can
increase the risk of recurrence," he says. "It may be that we need to
limit the use of PPIs to these patients and other patients who have a clear
need for protection."
Are All PPIs Equal?
Findings from a large Canadian trial, reported in late January, suggest that
all PPIs are not equal when it comes to inhibiting the antiplatelet activity of
The study included more than 13,000 heart attack patients treated with
Plavix with or without a PPI.
Study researcher David N. Juurlink, MD, PhD, tells WebMD that although most
PPIs did appear to interact with Plavix, one -- Protonix (pantoprazole, Wyeth
Pharmaceuticals) -- showed no evidence of reducing the effectiveness of the
Juurlink says he received no funding from Wyeth or any other drug company to
conduct his research.
"Literally millions of people who are taking Plavix and aspirin are also
taking a PPI," he says. "If a patient on Plavix requires a PPI, it
would seem to make sense to preferentially give them pantoprazole."
In late January, the FDA announced that Plavix manufacturers Bristol-Myers
Squibb and Sanofi-Aventis had agreed to conduct studies to clarify the impact
of PPIs and other drugs on the effectiveness of Plavix in heart patients.
"Patients taking clopidogrel should consult with their healthcare
provider if they are currently taking or considering taking a PPI, including
Prilosec OTC," the statement noted.
Wyeth Pharmaceutical spokeswoman Gwen Fisher tells WebMD that the company is
awaiting the results from these trials.
A spokesman for AstraZeneca, which makes Prilosec and Nexium, tells WebMD
that rigorously designed, prospective studies are needed to determine if PPIs
interact with Plavix.
"To date, there have been contradictory conclusions and scientific
limitations in studies about the potential interaction between clopidogrel and
PPIs," AstraZeneca spokesman Blair Hains says. "AstraZeneca believes
that before definitive conclusions are drawn, more evidence involving thorough,
well-designed, prospective clinical trials is needed."
Calls to Plavix manufacturer Bristol Myers Squibb were not returned by