Furuta Takahisa, Sugimoto Mitsushige, Kodaira Chise, Nishino Masafumi, Yamade Mihoko, Uotani Takahiro, Sahara Shu, Ichikawa Hitomi, Kagami Takuma, Iwaizumi Moriya, Hamaya Yasushi, Osawa Satoshi, Sugimoto Ken, Umemura Kazuo
Center for Clinical Research, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, 431-3192, Shizuoka, Japan.
First Department of Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan.
J Thromb Thrombolysis. 2017 Apr;43(3):333-342. doi: 10.1007/s11239-016-1460-2.
Proton pump inhibitors (PPIs) at low doses can effectively prevent gastrointestinal bleeding due to aspirin and are widely used in Japan for gastroprotection in patients taking anti-platelet agents. We examined the influence of different PPIs at low doses administered concomitantly or separately on anti-platelet functions of clopidogrel. In 41 healthy Japanese volunteers with different CYP2C19 genotypes who took clopidogrel 75 mg in the morning alone, or with omeprazole 10 mg, esomeprazole 10 mg, lansoprazole 15 mg, or rabeprazole 10 mg, either concomitantly in the morning or separately in the evening, we measured the inhibition of platelet aggregation (IPA, %) using VerifyNow P2Y12 assay at 4 h after the last clopidogrel dose on Day 7 of each regimen. IPA by clopidogrel with rabeprazole administered at lunchtime, approximately 4 h after clopidogrel, was also measured. Mean IPAs in those concomitantly receiving omeprazole, esomeprazole, lansoprazole or rabeprazole (47.2 ± 21.1%, 43.2 ± 20.2%, 46.4 ± 18.8%, and 47.3 ± 19.2%, respectively) were significantly decreased compared with those receiving clopidogrel alone (56.0%) (all ps < 0.001). This decrease was observed when PPIs were administered separately in the evening. However, IPA by clopidogrel with rabeprazole administered at lunchtime was 51.6%, which was markedly similar to that of clopidogrel alone (p = 0.114). All tested PPIs reduce the efficacy of clopidogrel when administered concomitantly. Our preliminary data suggest that administration of rabeprazole 4 h following clopidogrel may minimize potential drug-drug interactions.
低剂量质子泵抑制剂(PPIs)可有效预防阿司匹林所致的胃肠道出血,在日本被广泛用于接受抗血小板药物治疗患者的胃保护。我们研究了低剂量不同PPIs同时或分开给药对氯吡格雷抗血小板功能的影响。在41名具有不同CYP2C19基因型的健康日本志愿者中,他们于早晨单独服用75mg氯吡格雷,或与10mg奥美拉唑、10mg埃索美拉唑、15mg兰索拉唑或10mg雷贝拉唑同时在早晨服用,或在晚上分开服用,我们在每种方案第7天最后一次服用氯吡格雷后4小时,使用VerifyNow P2Y12分析测定血小板聚集抑制率(IPA,%)。还测定了在午餐时间(约在氯吡格雷给药后4小时)服用氯吡格雷与雷贝拉唑时的IPA。同时接受奥美拉唑、埃索美拉唑、兰索拉唑或雷贝拉唑的患者的平均IPA(分别为47.2±21.1%、43.2±20.2%、46.4±18.8%和47.3±19.2%)与单独接受氯吡格雷的患者(56.0%)相比显著降低(所有p值均<0.001)。当PPIs在晚上分开给药时也观察到了这种降低。然而,在午餐时间服用氯吡格雷与雷贝拉唑时的IPA为51.6%,与单独服用氯吡格雷时的IPA显著相似(p = 0.114)。所有测试的PPIs与氯吡格雷同时给药时都会降低氯吡格雷的疗效。我们的初步数据表明,在氯吡格雷给药4小时后给予雷贝拉唑可能会使潜在的药物相互作用最小化。