Clopidogrel (Plavix) Side Effects and Interactions

It is estimated that more than half a million stents are placed in coronary arteries every year. Some experts say it’s closer to 850,000.  We won’t get into the question of whether there are too many of these procedures performed annually. You can read about that controversy at this link. One disconcerting complication of heart stents is that they can become clogged. That’s why cardiologists often prescribe what is called dual antiplatelet therapy or DAPT to prevent blood clots. DAPT involves a drug like clopidogrel (Plavix) and low-dose aspirin (Circulation, Sept. 6, 2016).

Walking the Tightrope?

One of the biggest questions facing doctors and patients is: how long should a patient be kept on drugs like clopidogrel and aspirin? The DAPT trial was designed to answer that question (American College of Cardiology, Feb. 16, 2018). The results were confusing.

People who were assigned to dual antiplatelet therapy for 30 months had fewer blood clots develop in their stents and fewer heart attacks. That was compared to one year of treatment. Good news, right? The darker side of DAPT, however, was that patients have more bleeding episodes and a greater risk of dying the longer they take the two drugs. So, it really is a lot like walking a tightrope.

Another trial published in The Lancet (March 12, 2018) tried to answer the question: is six-months of dual antiplatelet therapy as good as 12 months? The answer: There were fewer blood clots and heart attacks in the group getting DAPT for 12 months compared to the six-month group. The authors concluded that one-year treatment remains preferable, even though there were more bleeding events.

What About Drug Interactions?

One reader asked a question we have seen before. Will acid-suppressing drugs like esomeprazole (Nexium) interfere with the effectiveness of clopidogrel?

Q. You might wish to tell readers to beware taking both clopidogrel (Plavix) and esomeprazole (Nexium). After installing a stent near my heart, my doctor said no changes were needed in my list of medications, even though I would be mixing Nexium with Plavix for the next year.

I checked this advice on our computer and saw another specialist. He immediately stopped the Nexium and changed my GERD medication to pantoprazole.

A. There is uncertainty about the interaction between acid-suppressing drugs like esomeprazole (Nexium) and the anti-clotting drug clopidogrel (Plavix) that you need to keep your stent open. Some studies suggest that the acid-suppressor will interfere with the effectiveness of Plavix or even aspirin. That is why you will find certain drug databases warn against combining clopidogrel with esomeprazole (Nexium) or omeprazole (Prilosec).

But new research has thrown the old wisdom into question. A study in the Journal of Stroke and Cerebrovascular Diseases (June, 2018) demonstrated that platelet aggregation (clumping) did not change when a PPI acid-suppressing drug was added to a drug like clopidogrel. The authors concluded:

“These data do not demonstrate a significant interaction between common individual PPIs and clopidogrel in healthy volunteers who respond to clopidogrel alone. This adds data to a growing body of evidence indicating that the addition of a PPI may have a weak effect on clopidogrel‘s antiplatelet properties, and may only be relevant in specific clinical circumstances.”

The People’s Pharmacy Perspective:

Always check with your cardiologist before making changes in drug treatment. Caution is extremely important when dealing with drugs like clopidogrel. Preventing blood clots and heart attacks is extremely important. But bleeding episodes can also be life-threatening. It truly is like walking a tightrope.

Pantoprazole (Protonix) appears to be a good choice with clopidogrel if a GERD medicine is needed (World Journal of Gastroenterology, May, 2012).

Plavix Side Effects:

• Bleeding (special danger with NSAID pain relievers like ibuprofen or naproxen-GI bleeding!)
• Itching
• Blood disorders
• Serious allergic reactions
• Skin rash (contact physician immediately!)

Share Your Own Experience with Clopidogrel:

How have you fared on clopidogrel (Plavix)? Share your story below in the comment section.

Revised 5/3/2018