Proton pump inhibitors
Posted: 14 July 2013 07:43 AM   [ Ignore ]
Sr. Member
RankRankRankRankRankRankRankRankRankRank
Total Posts:  2242
Joined  2012-10-27

Anyone have any information about this?  My husband takes PPI and Clopidogrel as recommended by his cardiologist.  McGyver?

I have a link to a recent Forbes article but it is blocked by CFI.

Profile
 
 
Posted: 14 July 2013 07:49 AM   [ Ignore ]   [ # 1 ]
Sr. Member
RankRankRankRankRankRankRankRankRankRank
Total Posts:  2242
Joined  2012-10-27

Here’s the link.  Precede it with http://www.Forbes.com

/sites/melaniehaiken/2013/07/12/common-acid-reflux-drugs-could-raise-risk-of-heart-disease-new-research-suggests/

Profile
 
 
Posted: 14 July 2013 03:39 PM   [ Ignore ]   [ # 2 ]
Sr. Member
Avatar
RankRankRankRankRankRankRankRankRankRank
Total Posts:  2018
Joined  2007-04-26

Here’s the quick explanation of what is going on here. PPI’s once absorbed are metabolized into an “inactive form” by an enzyme in the liver. Clopidogrel on the other hand once absorbed is metabolized to an “activated form” by the same enzyme in the liver.

When you have both medications in your system at the same time they compete for that enzyme. As a result they will not be metabolized as quickly and therefor PPI’s will not be inactivated as quickly ( resulting in higher levels of the active form) and Clopidogrel will not be activated as quickly resulting in less of the active form.

In most cases this difference in levels of active drug will not be clinically significant but you need to talk to your husbands doctor since there are alternatives he can use if his doctor feels the dose is crucial.

 Signature 

For every complex problem there is a solution that is simple, obvious,.... and just plain wrong

Profile
 
 
Posted: 14 July 2013 04:16 PM   [ Ignore ]   [ # 3 ]
Moderator
RankRankRankRankRankRankRankRankRankRank
Total Posts:  5169
Joined  2010-06-16

Interesting.  As long as we have you on the line, Mac, I have a mildly related question.  I have a Teflon lined stomach so I’ve never needed to inhibit its acid flow.  However, I also take Clopidogrel, and do so in the morning.  I also like to have grapefruit moderately frequently.  I saw a note that I should avoid this because the grapefruit changes the efficiency of the small intestine in that it increases the absorption. of some medications, decreases it of some, and has no effect on others.  I suppose I could take the Clopidogrel in the evening, (although I’d rather not), but I was wondering what, if any, effect it has on this medication. 

Occam

 Signature 

Succinctness, clarity’s core.

Profile
 
 
Posted: 14 July 2013 05:15 PM   [ Ignore ]   [ # 4 ]
Sr. Member
Avatar
RankRankRankRankRankRankRankRankRankRank
Total Posts:  2018
Joined  2007-04-26

Occam I checked the manufacturers package insert and it mentions nothing about an interaction with Grapefruit juice but the enzyme I was referring to above is known as CYP450. It is present in the liver and the lining of the intestine and it is known to be inhibited by some of the components of Grapefruit juice so I think its reasonable to assume that Grapefruit juice might result in a decrease in the activation of Clopidogrel.

Unfortunately I don’t know what the half life is of the inhibitory effect is so advising on a proper separation between grape fruit consumption and medication ingestion is difficult. The problem is this. There are several different compounds in grapefruit juice that effect the P450 family of enzymes although the most studied one is Bergamottin. Additionally not all of the enzymes in the P450 family are affected the same way by a given grapefruit compound. Finally each individual can vary markedly in how they are affected possibly due to minor differences in the structure of the enzymes they carry or perhaps related to how quickly that person produces new enzyme to replace the inhibited ones. In one study the change in the serum level of a particular blood pressure medicine changed by anywhere from -33% to 125% in different individuals after they consumed grapefruit.

If you really need to be on Clopidogrel and you want to be sure you are getting the proper dose you may need to give up grapefruit altogether or alternatively ask you physician if you need an anti platelet drug at all and if so is there an alternative you could use.

 Signature 

For every complex problem there is a solution that is simple, obvious,.... and just plain wrong

Profile
 
 
Posted: 14 July 2013 08:27 PM   [ Ignore ]   [ # 5 ]
Sr. Member
RankRankRankRankRankRankRankRankRankRank
Total Posts:  2242
Joined  2012-10-27
macgyver - 14 July 2013 03:39 PM

Here’s the quick explanation of what is going on here. PPI’s once absorbed are metabolized into an “inactive form” by an enzyme in the liver. Clopidogrel on the other hand once absorbed is metabolized to an “activated form” by the same enzyme in the liver.

When you have both medications in your system at the same time they compete for that enzyme. As a result they will not be metabolized as quickly and therefor PPI’s will not be inactivated as quickly ( resulting in higher levels of the active form) and Clopidogrel will not be activated as quickly resulting in less of the active form.

In most cases this difference in levels of active drug will not be clinically significant but you need to talk to your husbands doctor since there are alternatives he can use if his doctor feels the dose is crucial.

Thanks for the information, Macgyver. 

Lois

Profile
 
 
Posted: 15 July 2013 12:11 AM   [ Ignore ]   [ # 6 ]
Sr. Member
Avatar
RankRankRankRankRankRankRankRankRankRank
Total Posts:  7641
Joined  2008-04-11
macgyver - 14 July 2013 05:15 PM

If you really need to be on Clopidogrel and you want to be sure you are getting the proper dose you may need to give up grapefruit altogether or alternatively ask you physician if you need an anti platelet drug at all and if so is there an alternative you could use.

I really love grapefruit and grapefruit juice, but if I needed to take any medications on a regular basis, I would give it up. There are just too many metabolism problems with it.

 Signature 

Church; where sheep congregate to worship a zombie on a stick that turns into a cracker on Sundays…

Profile