Compromising Combinations

As disturbing as it might be to me, it appears that the FDA does not read my blog. I have written several times about the controversy concerning the combination of the drugs Plavix and the proton pump inhibitors. I and many other more prominent and learned cardiologists than I thought the controversy was resolved by the publication of the articles mentioned in my last blog on the subject.On November 17 during the American Heart Association meeting in Orlando, the FDA issued a public health warning on the “possible interaction” between Plavix and one proton pump inhibitor Prilosec.

Apparently the FDA was not swayed by the data from COGENT which I have reviewed in previous blogs. Maybe they know something that we have not been told. They have required the manufacturers to update the label of Plavix. The “label” is that piece of folded up tissue paper that you sometimes get with new drug prescriptions that is written in micro type and reads like Greek.

It should be noted that although no other members of the proton pump inhibitor class were mentioned, the drugs that the FDA recommended to use with Plavix are the H2 antagonists such as Pepcid or Zantac. Tagamet cannot be used as it is metabolized the same pathway that Plavix is and will have the same consequences that the use of Prilosec will.

If you are taking Plavix and need help with the risk of GI bleeding your doctor will be the person to ask what you should do. The “safest” decision may be to take the H2 blockers mentioned and forget about it. If doctors other than your primary doctor or cardiologist try to put you on other medication, it is your responsibility to help us and tell us all the medications you are on. It is always a wise idea to check with your primary doctor when any changes are made to your medications.

I can guarantee you that this is not the last we have heard on this topic. I will continue this discussion as data is presented.

Tags: COGENT, Plavix, Prilosec, Proton pump inhibitors
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