Interaction Between Plavix and Nexium

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Interaction Between Plavix and Nexium

Question:

I heard that using Nexium may reduce the effect of Plavix and that this can increase the chance of another heart attack. Is this correct?

Answer:

Yes, there is some concern that Nexium (esomeprazole) and related medications may decrease the effectiveness of Plavix (clopidogrel).

Nexium is a proton pump inhibitor. These are the most potent acid blockers. Others include omeprazole (Prilosec), pantoprazole (Protonix), lansoprazole (Prevacid) and rabeprazole (Aciphex).

Clopidogrel acts on platelets in the blood to decrease their stickiness and make the blood less likely to clot. People who have had a recent heart attack or angioplasty with the placement of a stent are routinely put on aspirin and clopidogrel to prevent blood clotting inside the stent.

Recent studies show that some proton pump inhibitors decrease the anti-platelet action of clopidogrel. Other studies suggest that people who take a proton pump inhibitor and clopidogrel may have a higher risk of a heart attack.

But there may be good reasons why a person needs a proton pump inhibitor. Aspirin and Plavix increase the risk of bleeding. Someone with a history of an active ulcer or intestinal bleeding should be on a strong acid blocker.

The experts are still sorting through this problem. Don't just stop taking your Nexium or Plavix. Talk with your doctor about whether you could possibly take a different medication to block or neutralize your stomach acid.

Howard LeWine, M.D., is chief editor of Internet Publishing at Harvard Health Publications. He is recognized as an outstanding clinician and teacher and is a recipient of the Internal Medicine Teacher of the Year award at Brigham and Women's Hospital. Dr. LeWine continues to practice Internal Medicine; most recently he became a hospitalist after practicing primary care for over 20 years.

Last updated:	July 20, 2009