Famotidine Does Not Reduce Recurrent Peptic Ulcers in Patients on Thienopyridines

Summary and Comment |
December 16, 2016

Famotidine Does Not Reduce Recurrent Peptic Ulcers in Patients on Thienopyridines

  1. David J. Bjorkman, MD, MSPH (HSA), SM (Epid.)

Histamine-2 receptor antagonists are not an effective substitute for PPIs for this purpose.

  1. David J. Bjorkman, MD, MSPH (HSA), SM (Epid.)

Patients taking thienopyridines (clopidogrel, ticlopidine) have an increased risk for bleeding from peptic ulcers. Proton-pump inhibitors (PPIs) can reduce this risk, but there is unfounded concern about potential interaction between these two drug types.

To evaluate the effect of famotidine, a histamine-2 receptor antagonist (H2RA), on the incidence of recurrent peptic ulcers and their complications in patients on thienopyridine therapy, investigators in Taiwan randomized 228 patients with a history of peptic ulcers taking a thienopyridine for atherosclerotic disease to receive famotidine 40 mg or placebo at bedtime for 6 months. Patients had no ulcers or erosions on an index endoscopy and underwent a second endoscopy at 6 months or as indicated for symptoms.

The 6-month cumulative incidence of recurrent peptic ulcers was similar in the famotidine and placebo groups (7% and 11%, respectively). Fewer erosions occurred in the famotidine group (21% vs. 37%; P=0.013). Peptic ulcer bleeding occurred in three patients on famotidine and two on placebo, and four thrombotic events occurred in each group.

Comment

These findings suggest that H2RAs do not protect against recurrent peptic ulcers in patients on thienopyridines. Larger studies are needed to rule out a weak protective effect. Ulcer risk reduction has been demonstrated in this setting using PPIs, even when concomitant aspirin is used. It is important to note that the in vitro interaction of PPIs and thienopyridines has not been demonstrated to be clinically significant in patients with a normal genotype for CYP2C19 (Am J Gastroenterol 2010; 105:2533). The potential benefit of PPI therapy for high-risk patients taking thienopyridines with or without aspirin outweighs the theoretical drug interaction.

Editor Disclosures at Time of Publication

  • Disclosures for David J. Bjorkman, MD, MSPH (HSA), SM (Epid.) at time of publication Leadership positions in professional societies World Gastroenterology Organization (President)

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