DEAR READER: Plavix is prescribed by physicians to prevent blood clots that could lead to heart attack or stroke in some patients. Prilosec (omeprazole) reduces the incidence of excess stomach acid. In November 2009, the Food and Drug Administration issued a warning to patients not to take one if you are on the other. New research suggests that when Prilosec and Plavix are taken, the ability to block platelet anticlotting may be reduced by almost 50 percent. Plavix alone isn’t capable of producing an anticlotting effect until it is metabolized or converted into an active form with the assistance of the liver enzyme CYP2C19. With the addition of Prilosec, this liver enzyme is blocked, substantially reducing the potential effectiveness of the Plavix.

Once the possible interaction was noted, the FDA requested additional studies from the manufacturer that supported the existence of a significant interaction that could negatively impact a person’s health. As a result, the Plavix label has been updated and now includes warnings regarding the use of Prilosec and other drugs that block the liver enzyme. It is unknown how other proton-pump inhibitors (PPIs) may interfere, but the recommendation is that Nexium, Tagamet and Tagamet HB, Diflucan, Nizoral, VFEND, Intelence, Felbatol, Prozac, Sarafem, Symbyax, Luvox and Ticlid also not be taken with Plavix because of the potential for similar interactions.
Any patient prescribed Plavix who needs medication to control stomach acid should speak with his or her physician for a recommendation of possible substitutes, such as Zantac, Pepcid, Axid and others that do not inhibit the CYP2C19 enzyme. So make a telephone call now or set up an early appointment with your doctor to resolve the issue.

To provide related information, I am sending you a copy of my Health Report “Consumer Tips on Medicine.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092, or download an order blank from my Web site, www.AskDrGottMD.com. Be sure to mention the title.

I am not interested in doing this if there is any other possible alternative. I would appreciate your thoughts on this matter.

DEAR READER:
Many studies have proven that atrial fibrillation (an erratic, fast pulse rate) can cause a stroke if a clot forms within the heart, breaks off, and is carried to the brain. Warfarin (Coumadin) appreciably reduces this risk. Therefore, I advise you to follow your doctors’ recommendations.

Coumadin is available in pill form, is inexpensive and easy to monitor. To my knowledge, there are no other inexpensive substitutes. Plavix is another pill, but is expensive and may need to be combined with aspirin for optimal effects. Other anti-coagulant drugs (such as heparin) are given by injection, are expensive and are not suitable for home care.

I suggest you take the Coumadin. With proper dosing and monitoring, it is safe.

To give you related information, I am sending you a copy of my Health Report “Coronary Artery Disease”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.