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Famotidine prevented antiplatelet drug-induced gastric mucosal injury
Histamine-2 receptor antagonist famotidine had a preventive effect on gastric injury induced by dual antiplatelet therapy with low-dose aspirin and clopidogrel, according to recent study data.
“We studied the effects of H2RA (eg, famotidine) on dual antiplatelet therapy-induced gastric mucosal injury in relation to intragastric pH level, CYP2C19 genotypes and Helicobacter pylori infection in a prospective manner,” the researchers wrote, “and showed that the preventive effect of an H2RA on gastric injury depended on gastric acidity, but not the presence or absence of H. pylori infection and CYP2C19 genotypes.”
Researchers randomly selected 20 individuals from a cohort of 118 healthy Japanese participants, grouped them by H. pylori status (10 positive, 10 negative). CYP2C19 genotypes — extensive metabolizer (EM) and intermediate or poor metabolizer (IM/PM) — were identified and represented equally for each group. Patients received 100 mg aspirin plus 75 mg clopidogrel (AC) once daily or AC plus 20 mg famotidine (ACH) twice daily for 7 days. Mucosal injury was evaluated by endoscopy on days 3 and 7 and 24-hour intragastric pH and antiplatelet-function test was done on day 7.
Day 7 median 24-hour intragastric pH in AC was 1.7 (1-4.3) vs. 3.6 (1.8-7.4) in ACH (P<.01). Day 7 median pH in ACH was similar between EM and IM/PM genotypes and was higher in H. pylori-positive compared with negative subjects (P=.034). Mucosal injury with ACH decreased in both day 3 (P=.006) and 7 (P=.002) compared with AC, irrespective of H. pylori and CYP2C19 genotype (P<.05). Antiplatelet effect of clopidogrel in EM was significantly greater than in IM/PM, but the additional famotidine had no influence, the researchers wrote.
“We demonstrated that famotidine is effective for the prevention of dual antiplatelet therapy-induced gastric mucosal injury and bleeding,” the researchers concluded. “Although a PPI rather than an H2RA is usually recommended … the present study demonstrated that famotidine treatment … effectively prevented gastric mucosal injury without attenuation of antiplatelet functions. In view of this efficacy, and less expensive cost, we have to investigate the clinical usefulness of famotidine in future prospective studies in a larger population.”
Disclosure: First Department of Medicine and The Center for Clinical Research at Hamamatsu University School of Medicine have received grants from Takedo Pharmaceutical, AstraZeneca KK, Eisai, and Daiichi-Sankyo.