Plavix plus heartburn meds could equal trouble

Nearly half of all patients taking the prescription medication Plavix [1] also take a heartburn medication, but that might not be such a great idea, according to new study findings presented Tuesday at the American Heart Association meeting in New Orleans.  

Medco Health Solutions conducted a study of 16,690 people and found the risk of heart attack or other cardiac trouble to be 50 percent higher in patients taking some combination of Plavix and a heartburn med than in those taking Plavix alone. In the past year, there were two additional studies with similar findings. 

At issue are a class of heartburn medications called proton pump inhibitors, which includes drugs like Wyeth's Protonix [2] and AstraZeneca's Nexium [3]. In the study, 6,828 of the patients were taking a proton pump inhibitor in conjunction with Plavix therapy, often to prevent common side effects of Plavix, which include stomach ulcers and bleeding.

The study might answer the questions on the minds of physicians and researchers following publication of a 2003 study in the journal Circulation by Paul Gurbel. Gurbel, a cardiologist at Sinai Hospital in Baltimore, found that close to 30 percent of patients did not process Plavix effectively, but the reasons for that were unclear.   

It turns out that proton pump inhibitors might interfere with liver enzymes that the body uses to process Plavix, rendering it less effective in some patients. 

At least some of the companies marketing the drugs have reserved judgment, however. A spokesperson for AstraZeneca said the company has not found any safety concerns in its own data and a spokesperson from Bristol-Myers Squibb said that, while the company would review the data, the retrospective nature of the study makes it more subject to confounding factors than randomized clinical studies are. 

Sanofi-Aventis and Bristol-Myers Squibb together market Plavix (clopidogrel), which is second best-selling drug worldwide.

- read the full Associated Press story [4]
- see what the Wall Street Journal said [5]
- find the Wall Street Journal blog post [6]
- get the study abstract [7]

Related Articles:
Plavix prevails in major Canadian ruling [8]
Setback for Lilly, gain for Plavix? [9]
Stopping Plavix may boost heart risks [10]
Stent, drug makers team up on clot study [11]
Adverse event reports hit record high [12]