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Possible drug-drug interaction between high-dose esomeprazole and phenprocoumon
M L Becker1, W P J Franken2, F Karapinar3
1Pharmacy Foundation of Haarlem Hospitals, Boerhaavelaan 24, 2035 RC, Haarlem, The Netherlands. mbecker@sahz.nl.
European Journal of Clinical Pharmacology
|September 25, 2015
Summary
Esomeprazole may slightly increase the anticoagulant effect of phenprocoumon, but the risk of over-anticoagulation remains low. This study investigated drug interactions between proton pump inhibitors and coumarin anticoagulants.
Area of Science:
- Pharmacology
- Drug Interactions
- Clinical Pharmacy
Background:
- Proton pump inhibitors (PPIs) like omeprazole are known to increase warfarin levels.
- The interaction between other PPIs, specifically (es)omeprazole, and the coumarin anticoagulants acenocoumarol and phenprocoumon is not well-established.
- Understanding these interactions is crucial for managing anticoagulation therapy and preventing adverse events.
Purpose of the Study:
- To investigate whether the co-administration of (es)omeprazole with acenocoumarol or phenprocoumon affects International Normalized Ratio (INR) levels.
- To assess the risk of over-anticoagulation in patients using (es)omeprazole concurrently with coumarin anticoagulants.
Main Methods:
- A retrospective analysis of hospital admissions involving patients using coumarins (acenocoumarol or phenprocoumon) and pantoprazole or (es)omeprazole concurrently for at least four days.
- Data collected included the highest recorded INR level and the incidence of INR above six.
- Comparisons were made between patients using (es)omeprazole or omeprazole and those using pantoprazole, a PPI with no reported interaction.
Main Results:
- No significant differences in INR levels were observed for acenocoumarol users across esomeprazole, omeprazole, and pantoprazole groups.
- Phenprocoumon users taking esomeprazole showed a significantly higher highest INR (4.7) compared to pantoprazole users (4.3).
- No significant difference in INR was found for phenprocoumon users taking omeprazole versus pantoprazole, nor was there a statistically significant increased risk of INR above six with esomeprazole.
Conclusions:
- Concomitant use of esomeprazole with phenprocoumon during hospitalization may enhance the anticoagulant effect.
- However, the clinical significance appears limited as no statistically significant increase in the risk of over-anticoagulation was detected.
- Further research may be warranted to fully elucidate the clinical impact of this potential interaction.
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