Information On Two Antithrombotics

Clopidogrel is used in the prevention and treatment of heart attack, stroke, blood clots, myocardial infarction, transient ischemic attacks and acute coronary syndrome (ACS). It is marketed as clopidogrel bisulfate (clopidogrel hydrogen sulfate), most commonly under the trade names Plavix. The drug prevents platelets in blood from clustering. This helps to prevent blood from forming blood clots.

Clopidogrel bisulfate is used to lessen the chance of heart attack or stroke. It is given to people who have already had a heart attack or stroke or to people with other blood circulation problems that could lead to a stroke or heart attack. A heart attack or stroke may occur when a blood vessel in the heart or brain is blocked by a blood clot. Clopidogrel reduces the chance that a harmful blood clot will form by preventing certain cells in the blood from clumping together.

The U.S. Food and Drug Administration (FDA) is reminding the public that it continues to warn against the concomitant use of Plavix and omeprazole because the co-administration can result in significant reductions in clopidogrel’s active metabolite levels and antiplatelet activity. This information was added to the drug label of Plavix in November 2009, and has been the source of continued discussion in the medical literature.

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary.

Patients at risk of heart attacks or strokes, who are given Plavix to prevent blood clots, will not get the full anti-clotting effect if they also take omeprazole. Omeprazole is found in prescription products (Prilosec, Zegerid, and generic products) and over-the-counter products (Prilosec OTC, Zegerid OTC, and generic products).

Results of the trial demonstrated that treatment with clopidogrel bisulfate(CAS No. 135046-48-9) reduced the risk of heart attack, stroke or cardiovascular death by 20% in subjects with mild heart attack or unstable angina. A variety of drugs that inhibit platelet function have been shown to decrease morbid events in people with established atherosclerotic cardiovascular disease as evidenced by stroke or transient ischemic attacks, myocardial infarction, or need for bypass or angioplasty.

With regard to the proton pump inhibitor (PPI) drug class, this recommendation applies only to omeprazole and not to all PPIs. Not all PPIs have the same inhibitory effect on the enzyme that is crucial for conversion of Plavix into its active form. Pantoprazole (Protonix) may be an alternative PPI for consideration. It is a weak inhibitor of CYP2C19 and has less effect on the pharmacological activity of Plavix than omeprazole.