January 26, 2023

In several observation studies, it has been suggested that a true pharmacologic interaction exists between clopidogrel (Plavix) and PPIs. Pharmacodynamic data suggest that competitive inhibition of CYP2C19 by PPIs decreases the availability of the active metabolite of clopidogrel and therefore diminishes its anti-platelet efficacy. This attenuation of anti-platelet effect of clopidogrel in conjunction with PPI has been supported in many platelet function studies and recent data has further shown that the decreased anti-platelet effect of clopidogrel translates into adverse cardiovascular outcomes.

Proton-pump inhibitors diminish the efficacy of globe inaugural dual antiplatelet therapy with aspirin and clopidogrel is generally prescribed for acute coronary syndromes but antiplatelet agents are associated with gastrointestinal bleeding major gastrointestinal bleeding increased from 0.7% in patients saw an aspirin alone 2.3 percent and those with aspirin and

Clopidogrel coll therapy during the 12 months proton pump inhibitors are frequently used along with clopidogrel to reduce the risk of gastrointestinal bleeding clopidogrel is a prodrug and requires two-step hawk sedation by hepatic cytochrome p450 enzyme system to convert clopidogrel into an active metabolite drugs which interfere with function of cytochrome p 2 c 19

May alter the act of metabolites of globo doggerel and thereby adversely impacting its antiplatelet activity proton pump inhibitors are competitive inhibitors of cytochrome p 2 c 19 to a varying degree in this instance clopidogrel and proton pump inhibitors have to compete for same iso enzyme which is involved in both of the oxidative steps for bio transformation of

Globo doggerel and to its active metabolite this may lead to a variable response and platelet aggregation these findings provide a possible explanation for the hypothesis that different proton pump inhibitors diminish antiplatelet activity of globo doggerel to a varying degree and this interaction leads to decreased inhibition of platelet activation as reflected in

Platelet function testing multiple warnings have heightened the awareness of ppi clopidogrel interaction on march 12 2010 the fda approved the third label changed for clopidogrel with a boxed warning regarding diminished clopidogrel efficacy in patients with decreased cytochrome p 2c 19 function due to genetic polymorphism recently the american college of cardiology

Taskforce published a clinical expert consensus document to make recommendations for practicing physicians relating to this issue therefore one should avoid combining clopidogrel and proton pump inhibitors unless there is a compelling indication one should also keep in mind that there is a 3% relevance of poor metabolizers at the same time it is prudent not to

Withhold proton pump inhibitors in patients at high risk for gastrointestinal bleeding in these patients pantoja so maybe the ppi of choice for low-risk patients serious consideration should be given to h2 receptor antagonists or antacids patients should also be advised to avoid self-medicating with omeprazole while they are on clopidogrel it is generally accepted

That proton pump inhibitors have various extents to which their hepatic metabolism depends on a given cytochrome p isoenzyme since panto brazil has lower affinity for cytochrome p 2 c 19 compared to omeprazole and esomeprazole panto brazil is expected to have more favorable drug drug interactions during the secondary biotransformation therefore there is growing

Support for patent all result as the ppi of choice with clopidogrel therapy thank you for watching for more videos subscribe to our channel

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Proton Pump Inhibitors (PPIs) Diminish the Efficacy of Clopidogrel By Clinical Updates