Published: 6 March 2014

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Update: PPIs and Clopidogrel Interaction

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Prescriber Update 35(1): 7
March 2014

The Medicines Adverse Reactions Committee (MARC) has reviewed information on clinical outcomes in patients taking proton pump inhibitors (PPIs) and clopidogrel. Previous in vitro studies had shown an interaction between omeprazole resulting in reduced efficacy of clopidogrel¹.

The MARC observed that available data indicate that patients who take PPIs have a greater number of co-morbidities that may predispose them to cardiovascular endpoints. The MARC recommended that whilst there is evidence that PPIs affect clopidogrel activity ex vivo, the available evidence suggests that this does not translate into adverse clinical outcomes.

In addition, the MARC also recommended that the available evidence does not show an increased risk of adverse cardiovascular outcomes when PPIs are used with aspirin.

The possible interaction between PPIs and clopidogrel was first reviewed by the MARC in 2010². At this time, there was limited information on the clinical significance of this interaction. Advice has previously been provided in Prescriber Update^3,4.

Further information on this topic can be found on the Medsafe website (www.medsafe.govt.nz/profs/adverse/Minutes156.htm#3.2.1).

References

1. Medsafe. 2013. Use of proton pump inhibitors and risk of adverse cardiovascular outcomes. Minutes of the 156th Medicines Adverse Reactions Committee Meeting 5 December 2013. URL: www.medsafe.govt.nz/profs/adverse/Minutes156.htm#3.2.1 (assessed 16 January 2014).
2. Medsafe. 2010. Clopidogrel and PPIs-Interaction. Minutes of the 143rd Medicines Adverse Reactions Committee Meeting 23 September 2010. URL: www.medsafe.govt.nz/profs/adverse/Minutes143.htm#3.5 (assessed 16 January 2014).
3. Medsafe. 2009. Clopidogrel and proton pump inhibitors — possible interaction. Prescriber Update 30(3): 18.
4. Medsafe. 2010. Clopidogrel and omeprazole — interaction now confirmed. Prescriber Update 31(1): 2.