Wednesday, June 17, 2009

Plavix Interaction with Proton Pump Inhibitors

There are new warnings concerning the concomitant use of Proton Pump Inhibitors (PPI's) (especially Prilosec and Nexium which are commonly used to prevent acid reflux or peptic ulcer disease) with a popular antiplatelet drug called "Plavix". Plavix which is used to prevent thrombotic stroke and transient ischemic attacks (TIA's) has been shown to have significantly reduced antiplatelet activity when used in combination with PPI's, thus increasing the inherent risks of developing stroke or TIA's. So far, this interaction seems to be more apparent with Prilosec (Omeprazole) and Nexium (esemeprazole). Protonix (pantoprazole) seems to be the least likely to cause this interact. Thus, doctors are now considering switching their patients to either Protonix or other classes of drugs that reduce gastric acid like H-2 blockers (not cimetidine) to prevent this possibly significant interaction.

Opinion:
My opinion regarding PPI's in general is stop their use altogether....if medically possible. They have been shown to increase the risk of fractures and increase the risk of pneumonia. Remember, we need acid to absorb calcium and gastric acid is also a natural barrier to invading organisms. Don't stop PPI's abruptly......they must be tapered over time (usually over a couple of weeks) to prevent a rebound effect (rapid increase of acid in your stomach). Remember, PPI's only serve to act as temporary band-aid for your real gastrointestinal issue(s).

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