"Considering all the available evidence, PPI use should be limited in patients taking clopidogrel, based on the physician's judgment," Stanek said.
PPIs are often prescribed to people taking Plavix, often to reduce the incidence of side effects such as nausea and heartburn. However, both Plavix and PPIs are metabolized by the same enzyme in the liver. So, the addition of a PPI can spur a less active form of Plavix to be produced, reducing its beneficial effects, experts say.
Prior studies have also shown an increased heart risk linked to these drugs in combination. In fact, the U.S. Food and Drug Administration issued an alert on the problem earlier this year and said it was investigating the possible relationship.
However, "this is not an emergency situation," said SCAI president Dr. Steven R. Bailey, director of the Janey Briscoe Center for Cardiovascular Research at the University of Texas Health Science Center in San Antonio.
"One of the biggest risks is that patients will discontinue clopidogrel [Plavix] therapy," Bailey said. He stressed that the standard recommendation is that anyone who has had a stent implanted should take the anti-clotting medication for one year, he said.
For people who are taking the combination of Plavix and a PPI, "if a change is contemplated, be sure your physician is aware of it," Bailey said. "The indication is not to stop taking these medications but rather have a discussion with your prescribing physician about the risks of taking these medications and their benefits."
In his clinical practice, Bailey said, he would consider continuing the combined drug therapy for stent recipients who had active gastrointestinal bleeding while taking Plavix. "They might benefit from PPI therapy," he said.
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