Heart and Heartburn Drugs May Not Mix Well
Preparations may relieve indigestion, constipation without side effects
(HealthDay News) -- Heartburn sufferers beware: If you're taking the clot-busting medication Plavix, you might not be getting the full effect of the drug if you're also taking certain proton pump inhibitors (PPIs) to block stomach acid.
The U.S. Food and Drug Administration first warned about the potential ill effects of the drug combination in January 2009. The agency issued the warning based on published reports showing that Plavix is less effective in some people than others.
Research involving nearly 17,000 Plavix users, presented at a meeting of the Society for Cardiovascular Angiography and Interventions, found that the incidence of major cardiovascular events, such as heart attack and stroke, were 51 percent higher among people taking a PPI, compared with those who were not taking that type of medication.
"Considering all the available evidence, PPI use should be limited in patients taking clopidogrel [Plavix], based on the physician's judgment," said Eric J. Stanek, senior director of research at Medco Health Solutions and an author of the study.
In an update issued in November, the FDA alerted the public and health providers about the risks of combining Plavix and Prilosec (omeprazole), which is available by prescription and in an over-the-counter formulation.
"New data show that when clopidogrel and omeprazole are taken together, the effectiveness of clopidogrel is reduced," the FDA said. "Patients at risk for heart attacks or strokes who use clopidogrel to prevent blood clots will not get the full effect of this medicine if they are also taking omeprazole."
The agency also cautioned against using other drugs that might interact with Plavix, including Nexium (esomeprazole). It did not make specific recommendations about combining Plavix with other PPIs on the market, citing a lack of information on potential drug interactions.
"Health-care professionals and patients should consider all treatment options carefully before beginning therapy," the agency said.
Heartburn sufferers taking Plavix have other options, though.
There's no evidence that H2 blockers, such as Zantac (ranitidine) and Pepcid (famotidine), or antacids interfere with Plavix, the FDA says.
And, it's OK for people who get heartburn to take both antacids and H2 blockers, according to the U.S. National Digestive Diseases Information Clearinghouse. Antacids neutralize acid in the stomach, whereas H2 blockers act on acid production.
Besides medication, people with heartburn should discuss possible lifestyle changes with a doctor, recommends the American Gastroenterological Association. These could include:
Avoiding food, beverages and medicines that relax the valve between the esophagus and the stomach or irritate the lining of the esophagus. These include fried or fatty foods, chocolate, peppermint, alcohol, coffee, carbonated beverages, ketchup, mustard, vinegar, tomato sauce, citric fruit or juices, aspirin and anti-inflammatory and pain medications (other than acetaminophen).
Decreasing the size of portions at mealtimes and not overeating.
Not lying down for two to three hours after eating meals.
Elevating the head of the bed four to six inches. If bed is not adjustable, try using blocks or telephone books.
Losing weight if you are overweight.
Avoiding situations that can increase pressure on the abdomen, which can cause more reflux. This includes avoiding tight clothing or control-top hosiery and body shapers. It also might mean not doing sit-ups, leg-lifts or abdominal crunches, as they, too, increase abdominal pressure.
Quitting smoking if you are a tobacco user.
On the Web
To learn more about heartburn, visit the American Academy of Family Physicians.
SOURCES: HealthDay News; May 6, 2009, news conference, Society for Cardiovascular Angiography and Interventions annual meeting, Las Vegas, Nev.; Eric J. Stanek, PharmD., senior director, research, Medco Health Solutions, Franklin Lakes, N.J.; U.S. Food and Drug Administration (www.fda.gov); Merck Manuals Online Medical Library (www.merck.com); U.S. National Digestive Diseases Information Clearinghouse (digestive.niddk.nih.gov); American Gastroenterological Association (www.gastro.org)
Author: Karen Pallarito
Publication Date: May 31, 2010
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