Combination of Clopidogrel and Proton Pump Inhibitors: Assessment of Pharmaceutical Interventions in the Emergency Department of Ibn Sina Hospital

• Published in: Drug safety 2021-12, Vol.44 (12), p.1432-1433
• Main Authors: Chaibi, A, Boudina, Y, Alilou, M
• Format: Article
• Language: English
• Subjects: Antiplatelet therapy; Aspirin; Biotransformation; Cardiovascular diseases; Clopidogrel; Emergency medical care; Emergency medical services; Guidelines; Health risks; Inhibitors; Metabolites; Omeprazole; Pharmaceuticals; Proton pump inhibitors; Protons; Risk; Risk reduction
• ISSN: 0114-5916; 1179-1942

Background/Introduction: Proton pump inhibitors (PPIs) are frequently associated with a dual antiplatelet therapy (Clopidogrel + Aspirin) especially in acute coronary syndrome to reduce the risk of gastrointestinal bleeding. Proton pump inhibitors are inhibitors of CYP2C19, which is involved in the biotransformation of Clopidogrel (prodrug) into active metabolites, thus reducing the biological response to Clopidogrel (1). The Proton pump inhibitors-Clopidogrel interaction is a matter of debate, as several studies have shown that certain PPIs are associated with an increased risk of cardiovascular events when combined with Clopidogrel (2, 3). Objective/Aim: Analysis of all prescriptions containing Clopidogrel and verification of the compliance of proton pump inhibitors prescribing with the guidelines and issuance of pharmaceutical interventions. Methods: We performed a prospective observational study of prescriptions including Clopidogrel, analyzed by the clinical pharmacist in the Emergency Department of Ibn Sina Hospital from February 2021 to May 2021, with issuance of pharmaceutical interventions. Results: The results showed that out of the total prescriptions analyzed (n = 56), 25% (n = 14) of them did not include a PPIs. And among the 75% (n = 42) with a PPI, 76% (n = 32) had Rabeprazole, 19% (n = 8) had Omeprazole, and 4.5% (n = 2) had Esomeprazole. A total of 32 pharmaceutical interventions were performed for 39.3% (n = 22) of the prescriptions: 68.75% (n = 22) of co-prescribing Rabeprazole, 25% (n = 8) stopping Omeprazole, and 6.25% (n = 2) stopping Esomeprazole, and all of them was accepted by the prescribers. Conclusion: This study shows that a significant number of pharmaceutical interventions were performed on prescriptions with Clopidogrel for the choice of the proton pump inhibitors as recommended on the guidelines, and that some prescribers were not aware of the impact of this interaction. These results will allow to raise awareness among prescribers of the importance of proton pump inhibitors in dual antiplatelet therapy and the risk of drug interactions.