Plavix and Pantoprazole interaction?

[tony969]

I have been taking Plavix for 3 years after MI back in 2009/100% occlusion of the left ventricle artery/.I have 2 bare metal stents and one DES inside those two in the same artery. Taking Diltiazem, Lisinopril, Aspirin and Ranitidine as well. Have been having constant stomach and chest pains and the doctors are not able to find the cause- at least they don’t think it is a cardiac one./the chest pains/ My gastroenterologist suggested I stop taking Ranitidine and switch to Pantroprazole. I have read a lot about the interaction between Plavix and PPI’s but he thinks only Omeprazole have more effect on Plavix, not Pantoprazole. Please, let me know what your opinion is and have you heard about any interaction between those two? I don’t need an additional heart attack.
Thank you for your response

[blackhorse16a]

I agree with your assessment, Coolshade.
I had an MI in 2003 due to blockage in my LAD. Two contiguos bare stents were implanted. They restenosed three months later and I had angioplasty with brachytherapy (which is obsolete now). Was on Plavix and Omeprazole for quite a while. Eventually went off Plavix and kept Omeprazole. LAD blocked again in 2013, and a DES was placed inside the other stents. These occluded again this past November and I had a double bypass (LAD plus RCA). The RCA veinous graft collapsed this month and a DES was placed last week.

Sooo, I am back on Plavix and Omeprazole. Thinking of maybe changing to Pantoprazole or just stopping PPI altogether. From my research, The PPI/Plavix interaction is no big deal. It looks like Plavix for a year after stent placement is a good idea.

[tony969]

I do agree with this. The reason I phrase it this way is we are worring too much about different things- I have done countless studies about medications, bleeding, side effects and the more I learn, the more anxiety I get:) Common sense as well as the knoweledge are very important, without overdoing things. A lot of things published on the Internet are far away from the truth- so do your home work but have a little trust in the doctors too:) Especially if they are good ones.

[Coolshade]

There is experimental evidence that pantoprazole has some effect on platelet aggregation in the lab but much less than omeprazole.  This doesn't translate to clinical findings which really show no significant effect from pantoprazole.  Part of this can be explained because, though people think that this is a wonder drug, clopidogrel reduces the incidence  of recurrent cardiovascular event only from about 11% to about 9%.  Advertiser would point to that and say it's a 20% reduction, but it is, in reality, only about 2% reduction.  The miracle of statistics makes this sigfnificant.  With that small a real reduction, those smaller still inflences from other drugs may not really show up unless they are impressive.. And pantoprazole isn't as impressive as omeprazole.  Mind you, even the NSRI class of antidepressants have some effect on bleeding to you have a higher risk of bleeding taking them with clopidogrel -.  Don't hear much about that, though.  

[tony969]

You should not worry about the clothing effect- there is none. I have spoken with many doctors about this and have not had a problem myself...since I am taking similar medications. Hope this helps

[Daniel14845]

Hi Jake,
First thanks for the information contained within your post.
I recently had a 100% blockage towards the bottom of my LAD.
A DES was put in place.
Now I am on Plavix, aspirin, imidapril for bp(small dose) Lipitor and Ranitidine 150mg.
My concern is the interaction of the Ranitidine and Plavix with the clotting affects. I take the Plavix in the morning and the Ranitidine in the evening about 1 hour prior to sleep.
Have you heard anything about the clotting affects when taking the meds at separate times of the day?
Thanks Much
Daniel

[tony969]

The acid reflux is a big problem for me too. I am still tapering Pantoprazole but acid reflux is there and most likely caused by the multiple medications I am taking. I am taking Pantoprazole and all other medications in the morning/except the statin/, Plavix at noon and Ranitidine at night. Horrible coctail and there is no escape:) Please, let me know how your blood work went.

[phyll50]

I had a heart attack in 2006, and my ulcer was bleeding at the time. I was on Nexium, and had just been switched to Prilosec. When I had the heart attack I had a 100o/o blockage and a 98% blockage and had 2 stents. I still have 6 small blockages so I cannot go off Plavix. My dr. took  me off prilosec and put me on Protonix until my ulcer healed, then I took Pepcid AC 20 mg. He has recently had to put me back on Nexium for severe acid reflux, but told me to take Plavix in the morn. and Nexium at night. Have to have some blood work done in 1 month.

[tony969]

I know...theoretically...in reality..there are studied that shows interraction. Doesn't matter- I am tapering off Pantoprazole and going off it. It seems the GI doctor finally agreed:)

[CCF CCF]

Although there were some studies to suggest an interaction between proton pump inhibitors and plavix on a molecular level, this interaction has not panned out in clinical studies and thus although some physicians may be cautious about prescribing these two medication, there is currently no contraindication to using both of these medications.

[tony969]

I will be very interested in this. Actually there are studies showing zero interraction between Prilosec and Plavix also so it is very difficult to see what this is. Thank you though and please keep me posted.

[jake162]

I have used Pantoprazole and Plavix since 8/2008.  My cardiologist took me off Prilosec due to concerns of interaction with Plavix.  I'm also on aspirin, ramipril, and metoprolol.  

I started having moderate chest pains in Nov/Dec 2012 and my BP spiked to 150/110 max with a 130/90 min.  I had also noticed that my blood was clotting almost instantly after a wound.  I have a cat with claws so blood-letting is common in my home.  In February, my cardiologist refused to renew the prescription for Pantoprazole, so I discontinued use on 2/4/2013.
I use Ranitidine once every 2 or 3 weeks, and found that club soda with my meals virtually eliminates any gastric discomfort.  What is significant, however, is that all chest pain disappeared and my feline-inflicted wounds now take a half hour or more to clot (as I would expect with Plavix and aspirin.)  Additionally, my BP now measures 129/85 max and 90/70 min.  I attribute slow breathing exercises (resperation) for the low min.  I have seen studies (contrary to most) that actually put the Pantoprazole at 39% reduction in Plavix efficacy.  In my layman's opinion, Pantoprazole has (at least, for me) had what I consider a life-threatening interaction with Plavix, and I recommend that everyone re-consider their choice of gastroesophageal meds.  I have an echo scheduled for 2/22 with a cardiologist followup in March.  If there's any interest, I'll keep you posted.

[tony969]

In my case I have two bare metal stents that clogged 3 months later after my heart attack. Then a DES was inserted inside those two bare metal stents which created so called "sandwich" stent...that's why it is kind of dangerous to stop it.

[jrbon]

I stopped  Plavix at once 1 year  after the DES stents implantation.

Consider that in your case, the DES stents have already lost, long ago, all the medicaments and you should not have more risk that if you had bare metal ones.

Jesus

[tony969]

Did you stop it at once or taper if off? How long have you been on Plavix? I really want to get rid of this medication but unfortunately am so affraid...

[ed34]

I have been off plavix for about six months now, and am just on Aspirin. I only noticed one difference from stopping the medication, breathing was easier. I have no idea why, but 24 hours after stopping plavix, I had to breathe less often. My average breaths per minute were around 12, now they are 10.

[tony969]

Unfortunately I never stopped Plavix. My stents are located in a place/called sandwich stents- DES is inserted into two bare metal stents/ and stopping Plavix may result in forming a cloth very rapidly. Unless the science comes up with something new or a substitute for Plavix, I don't want to take any chances. I had 100% oclussion of the mid left ventricle artery and almost died...life is still precious to me:)

[NoAnswersFromDoctors]

When you stopped the plavix, did your chest pain decrease?  My husband is in the SAME BOAT as you.  Severe chest and stomach pains ever since his initial cardiac event in March 2012 -- this resulted in placement of one stent in artery 90% blocked and no stent in another artery that was too small and 'kinked' to get a stent in.  He was put on several meds and sent home, and has never felt well since.  His chest pain is so bad that he tells me it hurts more now than when he went to the hospital in March.  They have run test after test and tell him the tests can't find anything wrong.  He was referred to Vanderbilt and was the so-called 'specialist' there looked at his test results and said 'Nothing looks wrong'. I suggested to him to ask his doctor if he could take half of his plavix meds for two weeks JUST TO SEE if that was the cause of his chest pain and the doctor outright refused to do that and bullied him that a clot would form on his stent if he tried to do this.  

[tony969]

I do agree with this. That's why my doctor stated that It might be necessary to take PPI's for life. I do know a person who had taken Nexium for 13+ years now and he is feeling good with no side effects. Maybe he is one of the licky ones:)

[ed34]

When I had esophagitis a short while back, it was explained to me by my Doctor that it isn't always a curable thing. Medication can often be for life to alleviate the symptoms. The trouble (she explained) is that there's a sphincter, ring of muscle at the junction of the stomach and esophagus. It's to prevent acid coming back up and the esophagus has no protection against stomach acid, it becomes very inflamed. She said with age, the sphincter can weaken and there's nothing that can be done apart from reducing acid production and looking at avoiding certain acidic food/drink.

[tony969]

Mine is plain acid reflux but aparently in "high doses":) I started taking 40 mg of Pantoprazole in the morning/before breakfast/ and one Ranitidine at night. Doctor suggested after a month to stop Ranitidine and continue only with Pantoprazole. I really hope this is going to help my undiagnosed chest pains.

[jrbon]

As you can see here:
http://www.rxlist.com/protonix-drug/indications-dosage.htm

Erosive esophagitis due to gerd, it should be solved in a max of 16 weeks.

If you only take it for that period, then I do not think that there is any issue. If you plan to take it for years, them I suggest to get yearly blood test for Vit. B12, Calcium and Magnesium. If necessary Vitamin B12 can be injected and Magnesium can be orally supplemented, I do not know about calcium (do not know if it exist in injectable form) any oral intake will not be assimilated unless that your stomach has a minimum acidity level

Jesus.

[ed34]

You're very kind and very welcome.

[tony969]

Thank you very much for your answer. I have been reading some of your postings and am quite impressed by your knowledge. It does help people and me particularly to hear different opinions. Thanks again

[tony969]

Thank you very much for yout detailed posting- really appreciate it. I am quite familiar with all the side effects and everything you mentioned- have done some research too. Tried to stop Plavix and almost got another heart attack- I have 3 stents and the third one is in a "sandwich"- so to make this short, I may have to be on Plavix indefinite. The paradox is that after I started Pantoprazole, my chest pains disapeared 99%. Yes, I have done endoscopy and did show some acid reflux- the gastroenterologist thinks though it is possible to be an Esophagus problem- he was very clear that sometimes even with normal results you can have problems. Believe me- I have seen every specialist here and no-one was able to "discover" what the problem is. This is the first time I am having some kind of relief. And yes- I do take 10 mg of Simvastatin, stopped it once but my chest pains did not disapear.
I would like to ask you a question though: You mentioned/whicn I know/ that "No assimilation of Calcium, Vitamin Bs, Magnesium (which can affect your heart), increased broken hips...". Any suggestion how to deal with this so can at least partially avoid those problems? Thank you again
Anatoly