Plavix, PPI Combo: Risky for Heart Patients?
Study Shows Risks of Combining Plavix and Proton Pump Inhibitors
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 taking Plavix.
"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 Plavix.
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 antiplatelet drug.
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 publishing time.