Monday, March 15, 2021

Hmm... the drug post

I've recently discovered that there is a potential negative interaction between Proton Pump Inhibitors (omeprazole - AKA Prilosec or Zegerid, esomeprazole - AKA Nexium, etc.) and Clopidogrel (AKA Plavix), which is an anti-platelet drug typically administered post myocardial infarction (heart attack), especially after coronary stent placement. Specifically, the proton pump inhibitors reduce the effectiveness of the anti-platelet drug, which probably isn't a great thing for someone depending on the anti-platelet drug to minimize likelihood of a recurrent myocardial infarction. Now, the studies, such as noted in this article (from 2010), are mostly retrospective studies, and there are some other studies which indicate there is not an interaction. At any rate, the current FDA info on Plavix (Clopidogrel) indicates that proton pump inhibitors, especially omeprazole, reduce the effectiveness of the anti-platelet drug. For those needing clopidogrel, a good recommendation would be to switch from omeprazole or esomeprazole to something like famotidine (Pepcid) or ranitidine (Zantac), although ranitidine is now subject to a voluntary recall due to potential cancer causing agents.

So, why am I blogging about this? Because I had a myocardial infarction, and was prescribed clopidogrel, and also have gastro-esophageal reflux disease (GERD), which I have been over-the-counter treating with Nexium (esomeprazole) for many years. I included "daily Nexium" on my list of medicines, both at the hospital when I was having my heart attack and stent placement, and at my primary care physician at the post-heart attack follow up visit (and it was already in my records there, too), and at my cardiologist when I started seeing him at my first cardiology follow up visit. None of these (nor any of the three pharmacists where I've filled the clopidogrel prescription) gave any warning of interaction between esomeprazole and clopidogrel. I only just found out about this interaction this week. Now, my GERD has been quite severe at times (I'll spare you the rather nasty details from occasional bouts of really bad reflux), and I've (mostly) managed it with the daily Nexium (over the counter dosage, not prescription dosage). 

Probably at least a portion of my GERD is a result of my poor dietary habits and my growing waistline. Both of these have been significantly improved since the heart attack; starting on the DASH diet once we left the hospital (with a stent in one of my coronary arteries) has helped on both fronts (along with tracking both my nutrition and my overall intake via My Fitness Pal) has reduced both the frequency and intensity of my reflux. With that in mind, it seems that a switch to a less potent acid reflux medicine, such as Pepcid, would be a viable thing to do, especially in light of the fact that I'm currently taking clopidogrel to minimize the likelihood of another heart attack (especially related to the stent, which the platelets might otherwise want to adhere to, I guess). 

I'm just wondering why none of the doctors suggested switching away from the Nexium to something that doesn't have any demonstrated negative impact on the clopidogrel. All the doctors had a full list of the medicines I routinely take, and all knew that I had a stent placed, and all knew that I was taking clopidogrel to minimize the risk of having another heart attack, or stroke, or adverse reaction to the stent which opened up my right coronary artery from 95% blocked to less than 10% blocked. Interestingly, in the hospital two weeks ago, they gave me Pepcid to combat any acid reflux instead of Nexium, so someone knew something. But they said nothing, and sent me home to continue taking both the clopidogrel and the esomeprazole. Until I came across this info on my own (and while actually looking for something else, looking into the drug interactions of clopidogrel, and saw omeprazole and esomeprazole on the top of the drug interactions list; then again, perhaps I should have paid more attention to the drug facts sheet from my first filling of the clopidogrel prescription, but I was also recovering from a heart attack, and the prescribing facility, although new to me and I to them, knew of my daily OTC dosing of Nexium, as well as any other medicines I took on a regular basis, so I didn't think I had any reason to need to question the prescription of the doctors there).

I guess the moral of this story is: don't take anything new for granted, especially when it comes to medicines. Be sure to read the whole pamphlet, and/or research the drug online, especially interactions if you're taking anything else (or want to take anything else). I suppose it should go without saying that illicit drugs shouldn't be included in any collection of medicines you're considering to take. But, there, I said it. And I'm about to go order some Pepcid on Amazon.

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