Optimising Proton Pump Inhibitor Therapy in Cardiovascular Polypharmacy: Expert Opinion and the Role of Rabeprazole

Abstract

Aim: To analyse the cardiovascular risks associated with proton pump inhibitors (PPIs) in patients with coronary artery disease (CAD) and provide guidance on selecting the most appropriate PPI to minimise drug interactions.

Background: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide, with significant prevalence in India. Anti-thrombotic therapy, including anti-platelet drugs and oral anti-coagulants, is standard for patients with CVD but is associated with a risk of gastrointestinal (GI) bleeding. Identifying high-risk patients and employing gastroprotective agents are critical in mitigating this risk. PPIs are commonly used for gastroprotection along with anti-thrombotic therapy, particularly in patients receiving dual anti-platelet therapy during acute coronary syndrome having a history of GI issues. However, PPIs can inhibit hepatic cytochrome P450 (CYP450) enzymes, potentially causing significant drug interactions. Therefore, selecting PPIs with minimal CYP450 interaction and monitoring patient compliance are essential for optimising therapy and reducing adverse interactions.

Review Results: This survey highlights the consensus among physicians regarding Rabeprazole’s safety, efficacy and suitability as the preferred PPI for patients with CVD undergoing anti-platelet therapy.

Discussion: This manuscript evaluates the cardiovascular risks associated with PPIs in patients with CAD and guides on selecting the most appropriate PPI, emphasising the importance of choosing agents with minimal CYP450 inhibition to reduce the risk of adverse interactions.

Clinical Significance: A PPI with minimal drug–drug interactions is advisable, particularly for patients receiving Clopidogrel or multiple medications. Rabeprazole is a suitable choice in such cases owing to its effective acid suppression and minimal interaction with other drugs.