What is The Best GERD Medicine to Take with Plavix?

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It was November 17, 2009 when the FDA gave a warning about Plavix-Nexium interactions. Plavix is an anti-thrombotic drug, essential for people with heart diseases. On the other hand, Nexium is a PPI important for GERD. If a patient is suffering from both

Plavix is a brand name of Clopidogrel. Manufactured by Sanofi-Synthelabo, it is normally available in 75 mg, film-coated tablets. Plavix is used as an  anticoagulant like Aspirin, Dipyridamol, and Heparin. These drugs make sure that the blood remains unobstructed and free flowing through the veins. Thus, these drugs are essential for preventing stroke and heart attacks. These drugs are also considered as maintenance drugs like the oral-hypoglycemic and antihypertensive types. In the case of Plavix and Nexium interactions, how can a doctor treat his patient’s gastrointestinal reflux disease if Nexium has been contraindicated with Plavix? Can an antacid or H2 receptor antagonist be a replacement for Nexium?

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GERD

GERD or Gastroesophageal reflux disease is a chronic condition. Once it begins, it is normally a ‘for life inconvenience’. It is a condition in which the liquid content of the stomach regurgitates or backs up into the esophagus. The liquid containing acid and pepsin, can inflame and damage the lining of the esophagus.

The common symptoms of uncomplicated GERD are primarily heartburn, regurgitation, and nausea.

The PPI or the Proton Pump Inhibitor

The proton pump inhibitor is actually the second type of drug developed specifically for acid-related diseases. These drugs include omeprazole (Prilosec, Omepron), lansoprazolee (Prevacid), rabeprazole (Aciphex), pantoprazole (Protonix), and esomeprazole (Nexium). A PPI blocks the secretion of acid into the stomach by shutting off the acid production of the enzyme pepsin.

Can an antacid treat GERD?

Antacids are usually nonprescription medications like the aluminum-magnesium combination (Maalox) or the calcium based (Tums). They can be indicated for uncomplicated peptic ulcer and gastric hyperacidity. But with GERD, they can be only used as aids or supplements for the rapid relief of its symptom as heartburn. More to this, although they can neutralize the acid in the stomach, that there is no acid to reflux, antacids action is brief. They are emptied from stomach so quickly, that the acid can re-accumulate in less than an hour.

H2 receptor antagonist treating GERD

Histamine stimulates acid production in the stomach. H2 receptor antagonists work by blocking the receptor for histamine and thereby preventing histamine from stimulating the acid-producing cells. The H2 receptor antagonist or the histamine antagonist, specifically cimetidine (Tagamet) was the first drug developed for GERD.

Besides cimetidine, other H2 antagonists including ranitidine (Zantac), nizatidine (Axid), and famotidine (Pepcid) are excellent for relieving the symptoms of GERD, particularly heartburn. However, these medications are not good for curing the inflammation (e.g. esophagitis) that may go with GERD. PPIs are used when H2 antagonists do not relieve symptoms effectively or when complications of GERD such as erosions or ulcers, strictures, or Barrett's esophagus exist.

The best GERD remedy alternative

PPIs may still be the best for GERD but considering the Plavix-Nexium interactions, H2 receptor antagonist – particularly nizatidine (Axid) and famotidine (Pepcid) can be the best alternative for PPIs.

Why nizatidine or famotidine?

According to the FDA, Nexium interferes with Plavix not because they are both proton pump inhibitors, but because they inhibit an enzyme CYP 2C19 that activates Plavix. Enzymes are proteins that speed up chemical reactions. Enzyme inhibitors like Nexium, diminishes the enzyme activity of Plavix that it lessens its action as an anticoagulant.

The FDA only warns about not using PPIs with Plavix or with any clopidogrel equivalent. On the contrary, the two H2 receptor antagonist, cimetidine and ranitidine should also be considered, being a strong and a weak enzyme inhibitor, consecutively. Nizatidine and famotidine do not interfere with the enzyme system, thus they are more recommendable for GERD.

Important: This article is solely for information. It is still best to seek advice from a registered physician.

References:

Wilson and Gisvold’s Textbook of Organic Medicinal and Pharmaceutical Chemistry 9th edition

http://www.webmd.com/heart-disease/news/20091117/fda-warns-plavix-patients-drug-interactions

http://en.wikipedia.org/wiki/Gastroesophageal_reflux_disease

http://en.wikipedia.org/wiki/Proton_pump_inhibitor

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