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Plavix, Proton Pump Inhibitor Warnings Revised in Canada

Sep 23, 2011 | Parker Waichman LLP

Health Canada is revising the label for Plavix in that country to reflect new information about the concurrent use of the blood thinner and other drugs called proton pump inhibitors (PPIs).   Many Plavix users take PPIs to counteract the ulcers and heartburn that can accompany use of the blood thinner.

In 2009, Health Canada updated the labels for ALL PPIs to recommend they not be used with Plavix, after some research indicated that the drugs could reduce the efficacy of Plavix.  But according to a statement issued yesterday, new studies indicate that not all PPIs impact Plavix in the same way.  Health Canada is now recommending that:

•    PPIs known to strongly or moderately reduce Plavix effectiveness should be avoided. Omeprazole (sold as Losec in Canada, and as Prilosec in the U.S.) is one of these.
•    If a PPI must be used in a patient taking Plavix, consider a PPI that does not interact as strongly. Pantoprazole is one of these.

In addition to omeprazole,  the new Health Canada  recommendations apply to the following PPIs:

•    Dexilant (dexlansoprazole)
•    Nexium (esomeprazole)
•    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.

PPIs are also available in combination with other drugs, for example Vimovo, which contains Nexium.

In 2009, the U.S. Food & Drug Administration (FDA) recommended that patients taking Plavix avoid Nexium and Prilosec because they could reduce the effectiveness of Plavix.  At the time, the agency said it was not known how other PPIs would impact Plavix.  The FDA also recommended that Plavix patients who needed relief from heartburn consider other drugs that don't interfere with its efficacy, including Maalox or Mylanta,  Zantac (ranitidine), Pepcid (famotidine), or Axid (nizatidine).

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