A  review of the interactions of Clopidogrel drugs with Proton Pump Inhibitors (PPIs) in the treatment of cardiovascular events

Diana Wijaya

doi:10.36452/jkdoktmeditek.v27i2.1966

Authors

Diana Wijaya Departemen Farmakologi, Fakultas Kedokteran dan Ilmu Kesehatan, Universitas Kristen Krida Wacana, Jakarta, Indonesia

DOI:

https://doi.org/10.36452/jkdoktmeditek.v27i2.1966

Keywords:

cardiovascular disease (CVD), clopidogrel, enzim CYP2C19, interaksi obat, proton pump inhibitors (PPI)

Abstract

Cardiovascular disease (CVD) merupakan salah satu penyebab kematian tertinggi di dunia dan obat antitrombosit memiliki peran yang signifikan sebagai terapi utama dalam kejadian kardiovaskular. Salah satu efek samping penggunaan obat antitrombosit jangka panjang dapat menyebabkan terjadinya perdarahan saluran cerna. Hal ini menyebabkan terapi obat antitrombosit seperti clopidogrel diberikan bersamaan dengan proton pump inhibitors (PPI). Penggunaan PPI jenis inhibitor CYP2C19 yaitu omeprazole dan esomeprazole dapat mengurangi efikasi clopidogrel secara signifikan dan meningkatkan risiko terjadinya infark miokard. Mekanisme kerja PPI dapat menghambat kerja clopidogrel karena adanya reaksi kompetitif kedua obat dalam proses metabolisme obat terutama enzim CYP2C19 karena clopidogrel memerlukan aktivasi enzim CYP2C19 untuk diubah menjadi metabolit aktif. PPI yang dapat direkomendasikan bersamaan dengan clopidogrel adalah pantoprazole, rabeprazole, lansoprazole dan dexlansoprazole karena menginhibisi CYP2C19 lebih lemah dibanding omeprazole dan esomeprazole.

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