Urtane Inga, Aitullina Aleksandra, Pukite Katrina
Department of Pharmacy, Riga Stradiņš University, Latvia.
J Young Pharm. 2013 Mar;5(1):18-21. doi: 10.1016/j.jyp.2013.01.002. Epub 2013 Mar 7.
Clopidogrel ineffectiveness is a serious problem in antiplatelet therapy. Many factors may contribute to this phenomenon. One of them is clopidogrel drug-drug interaction with CYP2C19 and CYP3A4 enzyme inhibitors. The main goal of this descriptive study was to assess the prevalence of cases of clopidogrel-drug interactions in the primary health care physicians' practices.
During 2010-2011, 80 patients receiving clopidogrel antiplatelet therapy from primary care physicians' clinical practices were involved in this study. By using questionnaires and case histories, the following information was collected: Age, gender, clinical diagnoses, and medications used.
IN THE CURRENT STUDY, DRUGS WERE USED THAT COULD POTENTIALLY INFLUENCE THE EFFECT OF CLOPIDOGREL: Omeprazole, lipophilic statins, calcium channel blockers (CCB). There was a different use of the above-mentioned drugs before and after the initiation of the clopidogrel therapy, e.g., 12 (15.0%) and 44 (55.0%) patients used proton pump inhibitors (PPI) before and after the clopidogrel therapy accordingly (P = 0.16; χ (2) = 1.91). However, pantoprazole was recommended more often than other PPI. The use of the potential CYP3A4 inhibitors - lipophilic statins and CCB - was increased after the prescription of clopidogrel too. Concomitant use of statins (mainly atorvastatin) with clopidogrel was observed in 75 (93.8%) patients and the use of CCB (mainly amlodipine) - in 33 (41.3%) patients.
In the primary health care practices, it is revealed that there is co-medication of clopidogrel with weak CYP3A4 inhibitors, such as lipophilic statins and amlodipine, and with the moderate CYP2C19 inhibitor - omeprazole. The latter co-medication is potentially harmful and it is very important to inform the first care professionals about the opportunity to change omeprazole to pantoprazole, which does not influence clopidogrel biotransformation.
氯吡格雷无效是抗血小板治疗中的一个严重问题。许多因素可能导致这一现象。其中之一是氯吡格雷与CYP2C19和CYP3A4酶抑制剂的药物相互作用。本描述性研究的主要目的是评估基层医疗医生临床实践中氯吡格雷药物相互作用病例的发生率。
2010年至2011年期间，本研究纳入了80例接受基层医疗医生临床实践中氯吡格雷抗血小板治疗的患者。通过使用问卷和病历，收集了以下信息：年龄、性别、临床诊断和使用的药物。
在本研究中，使用了可能影响氯吡格雷疗效的药物：奥美拉唑、亲脂性他汀类药物、钙通道阻滞剂（CCB）。氯吡格雷治疗开始前后上述药物的使用情况有所不同，例如，分别有12例（15.0%）和44例（55.0%）患者在氯吡格雷治疗前后使用质子泵抑制剂（PPI）（P = 0.16；χ(2)=1.91）。然而，泮托拉唑的推荐使用频率高于其他PPI。氯吡格雷处方后，潜在的CYP3A4抑制剂——亲脂性他汀类药物和CCB——的使用也增加了。观察到75例（93.8%）患者同时使用他汀类药物（主要是阿托伐他汀）和氯吡格雷，33例（41.3%）患者使用CCB（主要是氨氯地平）。
在基层医疗实践中，发现氯吡格雷与弱CYP3A4抑制剂（如亲脂性他汀类药物和氨氯地平）以及中度CYP2C19抑制剂——奥美拉唑存在联合用药情况。后一种联合用药可能有害，告知一线医疗专业人员将奥美拉唑更换为不影响氯吡格雷生物转化的泮托拉唑的可能性非常重要。
