Plavix and Omeprazole?

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pharmstud

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Is the interaction between the two of major concern? I have seen it in retail given together, but hospitals are different. Can anyone share their views?
Is it dose dependent? or is omeprazole always switched to lasoprazole?
Thanks
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In retail we always call to change it. I don't know about other places.
 
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Plavix is converted to its active metabolite by CYP2C19. All PPI's are substrates for CYP2C19, but to a varying degree. Which may alter the metabolism of Plavix and reduce effectiveness. The greatest decrease with PPI's and Plavix is seen with omeprazole.

Dexlansoprazole, lansoprazole, and pantoprazole have had studies done with Plavix and will inhibit CYP2C19, however minimally (clinically insignificant) and are considered safe without dosage adjustments.

Lansoprazole is chosen out of the three due to cost.

DAW
 
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The concerns arise from some retrospective studies that suggest that omeprazole reduces clopidogrel's anti platelet activity and worsens clinical outcomes.

Post-hoc analyses from randomized controlled trials (PRINCIPLE-TIMI 44 AND TRITON-TIMI 38) suggest that PPIs do not worsen clinical outcomes. PACA trial showed that patients on both pantoprazole and clopidogrel had better response than patients on omeprazole and clopidogrel.

Product labelling for clopidogrel has been updated to warn against its use with omeprazole.

Source: Pharmacistsletter.com

Based on the limited clinical data available, it would be prudent to suggest the switch of omeprazole to pantoprazole or lansoprazole just to cover your license.
 
They say there is an interaction but the latest study I got in medscape daily news (2-3 days ago) found that no interaction existed. It was a huge meta-analysis I think so it might not have been the best study out there.
 
At my hospital they don't change it. The reasoning is that some of the latest studies suggest that there isn't that much of an interaction. Omeprazole is formulary, so I guess they don't want to change to an H2 blocker.
 
The cardiologists in my area are not concerned about the interaction, and so we leave it (although a majority of the insurances in my area won't pay for any proton-pump inhibitors, so we don't see that many RX's for it--possibly people are just using it OTC.) If it's a family doctor adding it on, then I call them or the cardiologist if they want to defer it to them. The literature I've seen on the interaction is mixed--whether or not the interaction is clinically significant isn't clearcut.
 
my interactions with a highly trained cardiologist says he has no concerns
 
No interaction. Dispense as written.
 
pharmstud said:
Is the interaction between the two of major concern? I have seen it in retail given together, but hospitals are different. Can anyone share their views?
Is it dose dependent? or is omeprazole always switched to lasoprazole?
Thanks
Click to expand...

PDX always flags this as a Major drug interaction. I am usually more worried when omeprazole is being added when the patient is already on plavix, and not the other way around.
 
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