WAVE 3 TV Louisville, KY | Plavix doesn't mix well with some heartburn meds

Plavix doesn't mix well with some heartburn meds

By Lori Lyle - bio | email
Posted By Mike Dever - email

LOUISVILLE, KY (WAVE) - For heart disease, stroke patients and people at risk of a stroke, the clot-preventing drug Plavix is a lifesaver. But new studies indicate that when it's taken with a popular type of heartburn medication, the risk of a heart attack and death increases 25%. 

Forty-nine-year-old Mark Wolfe started taking Plavix in 2005 after a stroke. When he had a heart attack eight months later, doctors added aspirin to his regimen. It's a typical medication combination - as are the symptoms Mark says he felt soon after he started it. "The Plavix and aspirin caused a lot of stomach problems."

A scope of his stomach showed numerous ulcers, so doctors added a heartburn drug to help prevent internal bleeding. Known as Proton Pump Inhibitors - or PPIs - they are commonly sold under brand names such as Prilosec, Prevacid and Nexium.

Despite all the medications, Mark says he continued to suffer recurrent problems. "Within eight months after the stent work, the stents had clogged up. They did emergency heart surgery, they did a quadruple bypass, and after the quadruple bypass, within a year, the bypass clogged up."

Jewish Healthcare Cardiologist Dr. Jesse Adams says Mark's situation is not unique. "We're seeing an increase in incidence of recurrent disease, we're seeing an increase in incidence of heart attacks." 

Dr. Adams says studies are now pointing to Plavix taken with PPIs as the culprit. "If you're looking at all these studies, there's been between a 25 and 50 percent increase in the event rate." 

The problem, explains Adams, is that "Plavix has to be absorbed, it has to go through your liver and be metabolized." That's the same pathway used by most PPIs. Adams says that means "we get less Plavix effect; therefore, the platelets are able to stick to each other more and they're more prone to form blood clots."

And doctors say that's causing the recurrence of disease that's becoming so common among patients taking both drugs.

Mark is no longer taking Prilosec, and Adams says he's "pulling a lot of people off PPIs." And he says unless a Plavix patient is at high risk of an internal bleed, heartburn drugs classified as H2 blockers may be safer.

Dr. Adams says over-the-counter products like Zantac or Tagamet can replace PPIs for many patients taking Plavix.

For Mark, it's too soon to be certain that the medication change is working, but he remains positive. "Hopefully, we won't have anymore blockages."

There is one PPI, Protonix, that Adams says isn't metabolized through the liver, and in one study it didn't seem as harmful when taken with Plavix. 

If a patient is on any combination of Plavix and a PPI, Adams recommends calling your doctor and asking about your risks, but says don't stop taking a drug that's advised by your doctor until you've made that call.

Proton Pump Inhibitors:
Omeprazole (brand names: Losec, Prilosec, Zegerid, Ocid, Lomac, Omepral, Omez)
Lansoprazole (brand names: Prevacid, Zoton, Inhibitol, Levant, Lupizole)
Dexlansoprazole (brand name: Kapidex)
Esomeprazole (brand names: Nexium, Esotrex)
Pantoprazole (brand names: Protonix, Somac, Pantoloc, Pantozol, Zurcal, Pan)
Rabeprazole (brand names: Rabecid, Aciphex, Pariet, Rabeloc, Dorafem- combination with domperidone)

H2 BLOCKERS

Prescription Forms:
Tagamet (cimetidine)
Pepcid (famotidine
Axid (nizatidine
Zantac (ranitidine)
Nonprescription forms:
Tagamet-HB
Pepcid-AC
Axid AR
Zantac 75

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