Effects of pantoprazole and esomeprazole on platelet inhibition by clopidogrel

JM Siller-Matula, AO Spiel, IM Lang, G Kreiner… - American heart …, 2009 - Elsevier
JM Siller-Matula, AO Spiel, IM Lang, G Kreiner, G Christ, B Jilma
American heart journal, 2009Elsevier
BACKGROUND: Clopidogrel is activated by CYP2C19, which also metabolizes proton pump
inhibitors (PPI). As proton pump inhibitors (PPI) are metabolized to varying degrees by
CYP2C19, we hypothesized that the reported negative omeprazole-clopidogrel drug
interaction may not be a class effect. METHODS: Responsiveness to clopidogrel was
assessed by the vasodilator-stimulated phosphoprotein phosphorylation assay and
aggregometry (Multiplate Analyzer) in 300 patients with coronary artery disease (CAD) …
BACKGROUND
Clopidogrel is activated by CYP2C19, which also metabolizes proton pump inhibitors (PPI). As proton pump inhibitors (PPI) are metabolized to varying degrees by CYP2C19, we hypothesized that the reported negative omeprazole-clopidogrel drug interaction may not be a class effect.
METHODS
Responsiveness to clopidogrel was assessed by the vasodilator-stimulated phosphoprotein phosphorylation assay and aggregometry (Multiplate Analyzer) in 300 patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI).
RESULTS
The mean platelet reactivity index (PRI, assessed by vasodilator-stimulated phosphoprotein assay) was nearly the same in patients with (n = 226; PRI = 51%) or without PPI treatment (n = 74; PRI = 49%; P = .724). Likewise, the adenosine diphosphate–induced platelet aggregation did not differ significantly between patients with or without PPI treatment (45 vs. 41 U; P = .619). Similarly, there was no difference in the PRI or the adenosine diphosphate–induced platelet aggregation between patients with pantoprazole (n = 152; PRI = 50%; aggregation = 47 U), esomeprazole (n = 74; PRI = 54%; aggregation = 42 U), or without PPI (n = 74; PRI = 49%; aggregation = 41 U; P = .382).
CONCLUSION
In contrast to the reported negative omeprazole-clopidogrel drug interaction, the intake of pantoprazole or esomeprazole is not associated with impaired response to clopidogrel.
Elsevier
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