Impact of morphine on antiplatelet effects of oral P2Y12 receptor inhibitors

INTERNATIONAL JOURNAL OF CARDIOLOGY

卷:215

Review

Kubica, Jacek¹  Kubica, Aldona²  Jilma, Bernd³  Adamski, Piotr⁴  Hobl, Eva-Luise³  Navarese, Eliano Pio⁵  Siller-Matula, Jolanta Maria⁶  Dabrowska, Anita⁷  Fabiszak, Tomasz¹  Kozinski, Marek⁴  Gurbel, Paul Alfred⁸ 

[1] Nicolaus Copernicus Univ, Coll Med, Dept Cardiol & Internal Med, Bydgoszcz, Poland

[2] Nicolaus Copernicus Univ, Coll Med, Dept Hlth Promot, Bydgoszcz, Poland

[3] Med Univ Vienna, Dept Clin Pharmacol, Vienna, Austria

[4] Nicolaus Copernicus Univ, Coll Med, Dept Principles Clin Med, 9 Sklodowskiej Curie St, PL-85094 Bydgoszcz, Poland

[5] Univ Dusseldorf, Dept Internal Med, Div Cardiol Pulmonol & Vasc Med, Dusseldorf, Germany

[6] Med Univ Vienna, Dept Cardiol, Vienna, Austria

[7] Nicolaus Copernicus Univ, Coll Med, Dept Theoret Fdn Biomed Sci & Med Informat, Bydgoszcz, Poland

[8] Inova Heart & Vasc Inst, Inova Ctr Thrombosis Res & Drug Dev, Fairfax, VA USA

关键词: Morphine;    Clopidogrel;    Ticagrelor;    Prasugrel;    Drug-drug interaction;   

DOI  :  10.1016/j.ijcard.2016.04.077

来源: Elsevier

【 摘 要 】

Morphine and P2Y12 receptor inhibitors are both recommended in patients with acute myocardial infarction. Morphine may impede gastrointestinal absorption of several oral drugs including P2Y12 platelet receptor inhibitors. The aim of this review was to critically discuss drug-drug interactions between oral P2Y12 receptor inhibitors and morphine according to currently available knowledge based on the findings of experimental, observational and randomized clinical studies. The morphine-clopidogrel pharmacodynamic interaction has been observed in numerous trials and it has been proposed as an explanation for the negative impact of morphine on the clinical outcomes in patients with acute coronary syndromes. An analogous morphine interaction with ticagrelor and prasugrel was found in several observational studies and finally proven in randomized trials in healthy volunteers and acute myocardial infarction patients. Morphine delays and attenuates exposure and antiplatelet action of oral P2Y12 receptor inhibitors in patients with myocardial infarction. Although this interaction may have potentially harmful consequences, routine avoidance of morphine cannot be recommended until clinically powered trials are completed. (C) 2016 The Authors. Published by Elsevier Ireland Ltd.

【 授权许可】

Free