Harmsze Ankie M, de Boer Anthonius, Boot Henk, Deneer Vera H M, Heringa Mette, Mol Peter G M, Schalekamp Tom, Verduijn Monique M, Verheugt Freek W A, le Comte Marianne
St. Antonius Ziekenhuis, afd. Klinische Farmacie, Nieuwegein, the Netherlands.
Ned Tijdschr Geneeskd. 2011;155(28):A2442.
The drug interaction between proton pump inhibitors and clopidogrel has been the subject of much study in recent years. Contradictory results regarding the effect of proton pump inhibitors on platelet reactivity and on clinical outcome in clopidogrel-treated patients have been reported in literature. Concomitant use of omeprazole and clopidogrel was found to decrease the exposure (AUC) to clopidogrel's active metabolite by 50% and to sharply increase platelet reactivity, as a result of inhibition by omeprazole of CYP2C19, a cytochrome P450 (CYP) enzyme. Pantoprazole has a much weaker effect on clopidogrel's pharmacokinetics and on platelet reactivity during concomitant use. The influence of the other proton pump inhibitors when used simultaneously with clopidogrel has not yet been investigated in adequately randomized studies. Regulatory agencies state that the combination of clopidogrel and the CYP2C19 inhibitors omeprazole and esomeprazole should be avoided. To date, there is no conclusive evidence of a clinically-relevant interaction between any of the proton pump inhibitors and clopidogrel.
近年来，质子泵抑制剂与氯吡格雷之间的药物相互作用一直是众多研究的主题。文献中报道了关于质子泵抑制剂对接受氯吡格雷治疗患者的血小板反应性及临床结局影响的矛盾结果。由于奥美拉唑对细胞色素P450（CYP）酶CYP2C19的抑制作用，发现同时使用奥美拉唑和氯吡格雷会使氯吡格雷活性代谢物的暴露量（AUC）降低50%，并大幅增加血小板反应性。泮托拉唑在同时使用时对氯吡格雷的药代动力学及血小板反应性的影响要弱得多。其他质子泵抑制剂与氯吡格雷同时使用时的影响尚未在充分随机的研究中进行调查。监管机构指出，应避免氯吡格雷与CYP2C19抑制剂奥美拉唑和埃索美拉唑联合使用。迄今为止，尚无确凿证据表明任何一种质子泵抑制剂与氯吡格雷之间存在临床相关的相互作用。
