P2Y ₁₂ Receptor Antagonists and Morphine

Abstract

Abstract-P2Y 12 receptor antagonists, concurrently administered with aspirin in what has come to be commonly called dual antiplatelet therapy, are a mainstay of treatment for patients with acute coronary syndromes. Morphine, on the contrary, is a commonly used drug in the acute phase of acute coronary syndromes to relieve pain-with the added potential benefit of attenuating acutely raised sympathetic tone. In current guidelines, though, morphine is recommended with decreasing strength of recommendation. One reason is that it raises concern regarding the potentially significant interaction with antiplatelet agents, leading to impaired inhibition of platelet activation. In any case, it is still considered a mandatory part of the inventory of available medications in prehospital acute myocardial infarction management. The goal of the present review is to present published evidence on morphine and its potential interactions with P2Y 12 receptor antagonists, as well as on the central issue of whether such interactions may underlie clinically significant effects on patient outcomes.

Analgesic drug use in patients with STEMI: Current perspectives and challenges

“…This, in turn, may elevate heart rate and systemic vascular resistance ( 30 ). Therefore, restoring the blood supply to ischemic myocardium as soon as possible is the most effective way to relieve pain ( 31 ). A large number of patients still do not have immediate access to interventional treatment because of the local medical service.…”

Morphine in the Setting of Acute Heart Failure: Do the Risks Outweigh the Benefits?

“…51 A similar study revealed that the same effect is also relevant for ticagrelor administration. [52][53][54] Inhibition of oral drugs absorption may be directly relevant to the treatment of AHF in the setting of MI, but presumably may be also relevant to treatment with oral drugs for AHF (e.g. thiazides and neurohormonal inhibitors).…”

Intravenous antiplatelet therapies (glycoprotein IIb/IIIa receptor inhibitors and cangrelor) in percutaneous coronary intervention: from pharmacology to indications for clinical use

“…STEMI represents a clinical scenario where the timeliness of PCI, the hemodynamic instability with reduced gut transit and drug absorption, the administration of morphine and the frequent presence of nausea, vomiting, intubation, and cardiogenic shock impair the feasibility or efficacy of antiplatelet therapy with oral P2Y 12 receptor inhibitors. 79–89 In this context, i.v. administration of antiplatelet drugs could address such practical aspects, thus allowing for prompt and potent pharmacologic platelet inhibitory effects.…”