Drug-Drug Interaction Concerns With Plavix

By | 2022-02-08T17:39:37-05:00 April 6th, 2009|0 Comments

The U.S. Food and Drug Administration issued an early communication to alert healthcare providers and consumers to potential drug-drug interactions between the antiplatelet drug clopidogrel (Plavix) and proton pump inhibitors. Clopidogrel is a “pro-drug” — a substance that is not active until it is metabolized by the body. Recent studies have demonstrated that PPIs interfere with the metabolism of clopidogrel, causing it to be less effective in some patients than it is in others. Genetic differences may also be involved, and they are being investigated in ongoing studies.

Clopidogrel is used to prevent blood clots that could lead to heart attacks or strokes in at-risk patients. However, it can irritate the stomach and increase the risk for gastrointestinal bleeding. PPIs are commonly prescribed to reduce gastric and esophageal irritation. PPIs available by prescription only include omeprazole (Prilosec, Zegerid), lansoprazole (Prevacid), dexlansoprazole (Kapidex), pantoprazole (Protonix), rabeprazole (Aciphex), and esomeprazole (Nexium). Omeprazole is also sold over-the-counter as Prilosec OTC.

Healthcare providers are being asked to re-evaluate the need for treatment with prescription or over-the-counter PPIs in patients taking clopidogrel. There are other alternatives available to protect the stomach from irritation that do not interfere with the antiplatelet activity of clopidogrel, including the H2 blockers ranitidine (Zantac), famotidine (Pepcid), cimetidine (Tagamet), and nizatidine (Axid).

Antacids may also be used for gastric protection, including calcium carbonate (TUMS), calcium carbonate (Rolaids), aluminum hydroxide and magnesium hydroxide (Mylanta), and aluminum hydroxide and magnesium hydroxide (Maalox).

Patient teaching: Encourage patients using clopidogrel to consult their healthcare provider if they are also currently taking prescription or over-the-counter PPIs. It is also important to review the signs and symptoms of stroke and myocardial infarction with patients and their caregivers and stress seeking immediate emergency medical assistance.

Caution: Review current drug information before administering and monitoring medications.


Drug News is compiled by Susanne J. Pavlovich-Danis, RN, MSN, ARNP-C, CDE, CRRN, who maintains a private practice in Plantation, Fla., and is professor and area chair for nursing at the University of Phoenix, Fort Lauderdale.

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