Proton pump inhibitors in rheumatic diseases: clinical practice, drug interactions, bone fractures and risk of infections

Abstract

Patients affected by acute coronary syndrome (ACS) or by chronic inflammatory musculoskeletal and connective tissue diseases (i.e. systemic sclerosis), often need antiaggregant therapy (ASA or Clopidogrel). The concomitant use of proton pump inhibitors (PPIs) is suggested to reduce the risk of haemorrhage. Clopidogrel is a prodrug activated by cytocrome P 450. PPIs too have a CYP P450 metabolism, and a drug interaction has been observed between PPIs and clopidogrel. 25% of nonresponsiveness to clopidogrel is due to this drug interaction (1). Some studies have demonstrated that the use of PPIs is associated with an increased risk of bone fractures and Clostridium difficile infection.