Harvard Heart Letter

Heart Beat: Controversial warning on Plavix and stomach-protecting medications

In November 2009, the FDA sent a letter to doctors warning that omeprazole (Prilosec, Zegerid, generic) can halve the clot-blocking action of clopidogrel (Plavix). The letter recommended that omeprazole not be taken with Plavix. The alert is something of a turnabout, since omeprazole was once recommended as an antidote to the stomach upset Plavix can cause.

The warning seemed premature, since it didn't include results of the Clopidogrel and the Optimization of Gastrointestinal Events (COGENT) trial, which were presented at a cardiology meeting in September 2009. Among more than 3,600 men and women taking Plavix, rates of heart attack or other cardiovascular events were identical in those taking the drug plus omeprazole and in those taking Plavix alone, but there were fewer gastrointestinal problems in the combination group.

The FDA also warned that cimetidine (Tagamet, generic) and esomeprazole (Nexium), both used to quell or prevent heartburn, could also interfere with Plavix, but wasn't sure whether the other proton-pump inhibitors — lansoprazole (Prevacid), pantoprazole (Protonix), and rabeprazole (Aciphex) — did, too.

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