by Kazeem Olalekan MRPharmS
In August 2009 we reported a potential interaction between Proton pump inhibitors (PPI) and Clopidogrel. Subsequent to that report, Lancet concluded that PPI does not interfere with the clinical benefits of clopidogrel. The case frustrated me because in one week I was asking my GPs to review prescribing and in the other week, the evidence indicated this was unnecessary. The lesson from that saga is that the regulatory bodies need to be doubly clear about the totality of evidence before making recommendation.
The current advice from the CHMP (EU Committee for Medicinal Products for Human Use) is:
That said, there are a number of emerging issues with PPIs which were highlighted by the MHRA recently:
Report of hypomagnesaemia with PPI in long-term use
Prolonged use of proton pump inhibitors (PPIs) has been associated with hypomagnesaemia. Healthcare professionals should consider measuring magnesium levels before starting PPI treatment and repeat measurements periodically during prolonged treatment, especially in those who will take a PPI concomitantly with digoxin or drugs that may cause hypomagnesaemia (eg, diuretics).
Increased risk of bone fracture with PPI in long-term use – An epidemiological evidence
There is recent epidemiological evidence of an increased risk of fracture with long-term use of PPIs. Patients at risk of osteoporosis should be treated according to current clinical guidelines to ensure they have an adequate intake of vitamin D and calcium
The current issues with PPI does not require the stopping of PPI, rather it is about monitoring for magnesium and mitigating against fracture by taking vitamin D and calcium.