New Recommendations for Plavix, Heartburn Drugs Issued in Canada

Drug regulators in Canada have issued new recommendations for the concurrent use of <"">Plavix (clopidogrel) and <"">Proton Pump Inhibitors (PPIs). According to Health Canada, new evidence has shown that while PPIs do interact with Plavix, not all reduce the effectiveness of Plavix to the same degree.

Plavix is a prescription blood thinner given to people with a history of heart-related problems, such as heart attack and stroke, to prevent future events.

Heartburn and ulcers are possible side effects of Plavix, so such patients are often treated with a PPI to prevent these side effects. According to Health Canada, the drugs may include:

• Dexilant (Dexlansoprazole)

• Nexium (Esomeprazole).

• Losec (Omeprazol; sold under the brand name Prilosec in the U.S.)

• Prevacid (Lansoprazole)

• Pantoloc and Panto IV (Pantoprazol; sold under the brand names Protonix in the U.S.)

• Tecta (Pantoprazole/magnesium)

• Pariet (Rabeprazole; sold under the brand name Aciphex in the U.S.)

PPIs are also available in combination with other drugs, such as Vimovo, which contains esomeprazole.

In 2009, Health Canada updated the Plavix label to indicate that the use of any PPI in patients taking Plavix should be discouraged, as emerging data suggested that PPIs potentially reduced the ability of Plavix to protect against blood clots. But now, Health Canada says that studies conducted since then have shown that, while PPIs do interact with Plavix, not all PPIs interact to the same degree: some have a strong effect on Plavix, while others do not.

As such, the Plavix label in Canada has been updated again to reflect these new findings. In a statement issues yesterday, Health Canada made the following new recommendations regarding the concurrent use of Plavix and PPIs:

• PPIs known to strongly or moderately reduce Plavix effectiveness should be avoided. Omeprazole is one of these.

• If a PPI must be used in a patient taking Plavix, consider a PPI that does not interact as strongly. Pantoprazole is one of these.

In 2009, the U.S. Food & Drug Administration (FDA) issued a health alert warning that Prilosec and Nexium reduce the anti-clotting effects of Plavix. At the time, the FDA recommended that Plavix patients who need a medication to reduce stomach acid consider other drugs, including Maalox or Mylanta, Zantac (ranitidine), Pepcid (famotidine), or Axid (nizatidine), that are not believed to interfere with the anti-clotting activity of clopidogrel

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