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Canada Issues Recommendations For Plavix, PPIs

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Canada just issued recommendations for Plavix (clopidogrel) and heartburn drugs called PPIs (proton pump inhibitors) in light of new information indicating that although PPIs do interact with Plavix, not all PPIs impact efficacy in the same way. Health Canada said it is advising health professionals and patients with the updated recommendations.

Plavix is typically prescribed to patients with a history of heart-related problems, such as heart attack and stroke, to prevent future events, said Health Canada. The blood thinner been linked to some significant adverse reactions according to its label, specifically gastrointestinal and cerebral hemorrhaging, as well as eye (conjunctival, ocular, retinal) bleeding, musculoskeletal bleeding, fatal intracranial bleeding, respiratory tract bleeding, and skin bleeding.

Heartburn and stomach ulcers are also Plavix side effects. Because of this, Plavix patients may be given a PPI to ease or prevent these symptoms.

In 2009, Plavix labeling in Canada was updated to indicate that PPI use in patients taking Plavix should be discouraged based on emerging data suggesting that PPIs potentially reduce the ability of Plavix to protect against blood clots. Since, new studies have shown that, while PPIs do interact with Plavix, not all PPIs interact to the same degree. Some have a strong effect on Plavix, while others do not, Health Canada said.

Health Canada wrote that Plavix labeling has been updated with new recommendations regarding the use of PPIs and that PPIs known to strongly or moderately reduce Plavix effectiveness should be avoided. Omeprazole is one of these. Health Canada also noted that if a Plavix patient must use a PPI, physicians should consider one that does not interact as strongly. Pantoprazole is one of these.

Patients taking Plavix should continue taking it as directed, but should speak to their health professional if concerned about treatment. Health Canada notes that there are alternatives to PPIs for the treatment of stomach ulcers and heartburn.

According to Health Canada, Protopump inhibitors are available under the following brands and some generic equivalents: Dexilant (dexlansoprazole), Nexium (esomeprazole), Losec (omeprazole, sold as Prilosec in the U.S.), Prevacid (lansoprazole), Pantoloc and Panto IV (pantoprazole, sold as Protonix in the U.S.), Tecta (pantoprazole/magnesium), Pariet (rabeprazole, sold as Aciphex in the U.S.). In Canada, PPIs are also available in combination with other drugs, for example Vimovo, which contains Nexium.

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