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Study on the Interaction between Deuterium Clopidogrel and Omeprazole.

Zhiping Xu1, Liang Chen1, Yingze Liu1

  • 1School of Pharmaceutical Sciences, Jilin University, Changchun, China.

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|March 13, 2022
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Deuterium clopidogrel (D-CL) shows reduced interaction with omeprazole, maintaining better antiplatelet and antithrombotic effects. This new formulation may overcome clopidogrel

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Area under the curveCytochrome P450 enzymesDeuterium clopidogrelDrug-drug interactionOmeprazole

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Area of Science:

  • Pharmacology
  • Cardiovascular Medicine
  • Drug Metabolism

Background:

  • Dual antiplatelet therapy (DAPT) with aspirin and P2Y12 inhibitors is crucial for acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI).
  • Proton pump inhibitors (PPIs) are used with DAPT to prevent gastrointestinal bleeding, but some PPIs, like omeprazole (OM), can reduce clopidogrel's (CLP) antiplatelet activity.
  • This interaction occurs because both CLP and OM are metabolized by cytochrome P450 (CYP450) enzymes, specifically CYP2C19, leading to potential cardiovascular event recurrence.

Purpose of the Study:

  • To develop a novel formulation of clopidogrel that minimizes drug-drug interactions with PPIs.
  • To evaluate the pharmacokinetic and pharmacodynamic properties of deuterium-labeled clopidogrel (D-CL) when co-administered with omeprazole.

Main Methods:

  • Synthesis of D-CL using selective deuterium technology.
  • Assessment of CYP450 enzyme activities using the cocktail method.
  • Measurement of thiol active metabolites (AM) via HPLC-MS/MS.
  • Evaluation of platelet aggregation using the Born method.
  • Analysis of thrombus formation and clot strength using electro-stimulated thrombus generation and thrombus elastography.

Main Results:

  • D-CL demonstrated significantly less inhibition of CYP450 enzyme activities when combined with OM compared to standard CLP.
  • The area under the curve for active metabolites (AM) of D-CL was greater in the presence of OM.
  • D-CL exhibited superior antiplatelet and antithrombotic effects compared to CLP when co-administered with OM.

Conclusions:

  • Deuterium-labeled clopidogrel (D-CL) effectively reduces drug-drug interactions with omeprazole.
  • D-CL offers a promising alternative to standard clopidogrel, potentially mitigating cardiovascular risks associated with PPI co-therapy.