annual medication therapy management appointment
A 68-year-old man presented to his community pharmacy for his annual medication therapy management appointment. During the interview, the pharmacist established that the patient’s medical history included hypertension, diabetes mellitus, and coronary artery disease. Three months earlier, following a myocardial infarction, the patient had surgery for the placement of a drug-eluting stent. His current medications included lisinopril 20 mg daily, metoprolol succinate 100 mg daily, aspirin 81 mg daily, atorvastatin 80 mg daily, metformin 1000 mg twice a day, and clopidogrel 75 mg daily. The patient revealed that over the past month he had been suffering from indigestion and heartburn. In addition to nonpharmacological modalities, the patient tried antacids and H2-receptor antagonists, all of which failed to provide lasting relief. Concerned about a possible gastrointestinal bleed, the pharmacist asked the patient whether he had been experiencing associated signs or symptoms, which he denied. Based on the patient’s presenting reflux symptoms and inadequate response to previous treatments, the pharmacist reasoned that a proton-pump inhibitor (PPI) might be appropriate. However, aware of the well-established debate about the concomitant use of clopidogrel and PPIs, the pharmacist reflected on recent research findings and sought more information from the patient to determine whether to recommend PPI therapy.
Clopidogrel-PPI Interactions?
