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Hi i’m greg cummings pharmacist and host of pharmacy pearls in my experience many healthcare providers remain uncertain about how best to handle a well known drug interaction between clopidogrel and proton pump inhibitors in this edition of pharmacy pearls i’m going to summarize an excellent editorial by dr. david juror link professor of medicine at the university of
Toronto which was published in the journal circulation in 2009 it discusses the nature of the interaction its importance for patients as well as three simple management strategies for dealing with it please stay tuned to the end of the video for a link to the article first of all clip integral is used to prevent heart attack stroke and vascular death in people with
Established heart disease it is a prodrug meaning that it gets converted to its active form within the body in this case through metabolism by multiple liver enzymes with one called sip to see 19 being of particular importance similarly proton pump inhibitors or ppis for short also get metabolized by sip to see 19 as a result when taken together the two medications
Inhibit the activity of the enzyme through a mutually exclusive competition for metabolism it is this process that forms the theoretical basis for the drug interaction for people taking clopidogrel the pro drug this could possibly mean a higher risk of dying in light of this and the fact that tens of millions of people take these medications together it certainly
Merits careful consideration at the same time there are several reasons to believe that the magnitude of the interaction is small to begin with while ppi is lower the effective clopidogrel they do not abolish it in other words despite the interaction clopidogrel will still continue to exert some effect additionally the interaction notwithstanding clip integral
Itself has only a modest benefit for instance dr. gerling colludes to the cure study wherein one person benefited from treatment for every 47 people taking capital grille the other forty six did not and you can’t be harmed by this interaction if you are not destined to benefit from treatment in the first place finally the effect of clopidogrel is only diminished
When levels of the ppi are high enough to interfere with its metabolism because most ppis are rapidly eliminated from the body the combination should only be problematic when taken together in close temporal sequence in summary the interaction will be insignificant for most patients nonetheless there are three simple management strategies to easily deal with this
Interaction in clinical practice first of all you should assess the need for a ppi in the first place while necessary for some patients in many cases a medication like ranitidine or an antacid will suffice next consider using pan top resolve first-line if a ppi is required because evidence suggests that it is the most favorable agent within the class conversely
Lens offers all is the most potent sip to see 19 inhibitor and is likely best avoided lastly stagger the dosing of the two medications if the ppi is given at least four hours after clopidogrel it should minimize the risk of interaction thanks for watching hopefully you now understand how best to handle the drug interaction between clopidogrel and proton pump
Inhibitors to read the editorial on which this video is based visit firma sea pearls calm / clip integral ppi for more pharmacy pearls please subscribe to my youtube channel
Transcribed from video
Handling The Clopidogrel – Proton Pump Inhibitor (PPI) Drug Interaction By Pharmacy Pearls
