Changing Prescription Pattern of Omeprazole Among Patients Receiving Clopidogrel

Abstract

SummaryRecent studies have suggested that omeprazole may reduce the inhibitory effect of clopidogrel on platelet aggregation. The United States Food and Drug Administration (FDA) has issued an update regarding this drug-drug interaction.This study aimed to evaluate the changing prescription pattern of omeprazole in patients taking clopidogrel after the FDA update regarding the clopidogrel-omeprazole interaction.A pharmacy database system was used to identify all prescriptions of clopidogrel alone, clopidogrel and omeprazole, or clopidogrel and ranitidine from May 1, 2009 until May 31, 2010.A total of 2,899 prescriptions were entered into the fi nal data analysis. There was a statistically signifi cant drop in omeprazole prescription with clopidogrel from 46.6% in the period before the FDA update to 38.2% after the update (P = 0.0037). In addition, a signifi cant increase was observed in the ranitidine prescription from 9.7% to 20.1% during the same time frame (P = 0.0059) without any signifi cant change between the two study periods for those on clopidogrel alone without any protective gastrointestinal bleeding drug (43% versus 41.7%). On the other hand, of the 732 patients who were on clopidogrel and omeprazole during the period before the FDA update, 396 patients (54.1%) were taken off omeprazole, 274 (37.4%) were kept on both drugs, 59 (8.1%) had their omeprazole switched to ranitidine after the FDA update, and 3 patients were lost to follow-up (0.4%).The present fi ndings indicate a signifi cant change in prescription pattern for omeprazole after the FDA update by taking patients off omeprazole or to a lesser extent replacing it with ranitidine. (Int Heart J 2014; 55: 93-95)

Real-World Relationship Between Proton Pump Inhibitors and Cerebro-Cardiovascular Outcomes Independent of Clopidogrel

“…14) Re-cently, a study indicated significant changes in the prescription pattern for omeprazole after the FDA update by taking off omeprazole from the patient's prescription or, to a lesser extent, replacing it with ranitidine. 15) Consequently, a retrospective cohort study, which included 56,406 participants discharged after first-time MI, demonstrated that PPIs are associated with an increased incidence of cardiovascular death, recurrent MI, or stroke, regardless of clopidogrel use. 16) Furthermore, these risks may extend from patients with coronary artery disease to the general population.…”

Irrational Prescribing Habit of Omeprazole

“…7 Additionally, PPI has been linked to other adverse events in the recent past that comprise the clopidogrel (Plavix) resistance, reduced levels of magnesium, which results in elevated leg spasms risks, seizures, arrhythmias, cardiac birth defects when used by a pregnant woman, osteoporotic fractures from persistent use. 10 Similar findings are reflected in a warning issued by the FDA, indicating that omeprazole a PPI has the potential to minimize the antithrombic effect of clopidogrel when the two are concomitantly consumed to almost half. The study noted a drastic reduction in the number of patients that were undergoing combination therapy with one-third still using the combination therapy even after the FDA Safety warning.…”

The Association between Co-Administration of Omeprazole and Clopidogrel and Cardiovascular Outcomes

“…Hypertension and severe coronary stenosis are known risk factors for thrombotic cardiac events. Taken together, these three profiles may help predicting which patient may have a higher risk of adverse outcomes when given clopidogrel together with omeprazole [89][90][91].…”