Hunfeld Nicole G M, Valkhoff Vera E, Touw Daan J, Sturkenboom Miriam C J M, Kuipers Ernst J
Apotheek Haagse Ziekenhuizen/HagaZiekenhuis, Ziekenhuisapotheek, Den Haag, the Netherlands.
Ned Tijdschr Geneeskd. 2011;155(28):A2404.
As both proton pump inhibitors (PPIs) and clopidogrel are metabolized by CYP2C19, an enzyme of the cytochrome P450 system, this could lead to drug competition. Recent studies have raised concerns that interaction of PPIs and clopidogrel could reduce the efficacy of clopidogrel and thus increase events such as myocardial infarction. This has resulted in opposing opinions and controversial recommendations. Optimal protection of patients at high risk for cardiovascular events is warranted. On the other hand, optimal gastroprotection for patients at risk for gastrointestinal bleeding is of clinical relevance. Despite the large number of studies, current evidence does not support the existence of an interaction between PPIs and clopidogrel. In agreement with international guidelines the approach of providing this combination therapy to those patients with an accepted indication for gastroprotection and secondary cardiovascular prevention is justified.
由于质子泵抑制剂（PPIs）和氯吡格雷均由细胞色素P450系统的一种酶CYP2C19代谢，这可能导致药物竞争。最近的研究引发了人们的担忧，即PPIs与氯吡格雷的相互作用可能会降低氯吡格雷的疗效，从而增加心肌梗死等事件的发生。这导致了相反的观点和有争议的建议。有必要对心血管事件高危患者进行最佳保护。另一方面，对有胃肠道出血风险的患者进行最佳胃保护具有临床意义。尽管有大量研究，但目前的证据并不支持PPIs与氯吡格雷之间存在相互作用。与国际指南一致，为那些有胃保护和二级心血管预防公认适应症的患者提供这种联合治疗的方法是合理的。
