NEW YORK (Reuters Health) Oct 02 - In patients with coronary stents for non-ST-segment elevation acute coronary syndrome, use of pantoprazole instead of omeprazole as a proton pump inhibitor (PPI) allows a better platelet response to clopidogrel, French researchers report.
In the September 22nd issue of the Journal of the American College of Cardiology, Dr. Thomas Cuisset of CHU Timone, Marseille, and colleagues observe that omeprazole reportedly decreases clopidogrel's antiplatelet effect, perhaps in association with CYP2C19-related mechanisms involved in PPI metabolism.
To determine whether this was a class effect, the researchers randomized 104 patients after cardiac stent placement to treatment with 20 mg of pantoprazole or 20 mg of omeprazole daily, along with dual antiplatelet therapy with 75 mg of aspirin and 150 mg of clopidogrel.
At 1 month, response to clopidogrel, as assessed by platelet reactivity index vasoactive stimulated phosphoprotein, was significantly better with pantoprazole.
Furthermore, 44% of patients in the omeprazole group were nonresponders to clopidogrel, compared to 23% of patients in the pantoprazole group.
The investigators conclude that "the degree of the interaction between clopidogrel and PPI is not homogeneous within the class of PPIs and is less marked with pantoprazole than with omeprazole."
As Dr. Cuisset told Reuters Health, "For clopidogrel-treated patients requiring a PPI," the study findings suggest "the preferential use of pantoprazole compared to omeprazole to avoid any potential negative interaction with CYP2C19."
Reference
J Am Coll Cardiol 2009;54:1149-1153.
1 comments:
Pantoprazole may also be used to prevent ulcers .To evaluate the efficacy of pantoprazole in preventing gastrointestinal lesions in patients with rheumatic diseases receiving continuous long term treatment.
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