Impact of morphine on antiplatelet effects of oral P2Y12 receptor inhibitors

Jacek Kubica; Aldona Kubica; Bernd Jilma; Piotr Adamski; Eva Luise Hobl; Eliano Pio Navarese; Jolanta Maria Siller-Matula; Anita Dąbrowska; Tomasz Fabiszak; Marek Koziński; Paul Alfred Gurbel

doi:10.1016/j.ijcard.2016.04.077

Impact of morphine on antiplatelet effects of oral P2Y12 receptor inhibitors

Jacek Kubica, Aldona Kubica, Bernd Jilma, Piotr Adamski, Eva Luise Hobl, Eliano Pio Navarese, Jolanta Maria Siller-Matula, Anita Dąbrowska, Tomasz Fabiszak, Marek Koziński, Paul Alfred Gurbel

School of Medicine

Research output: Contribution to journal › Review article › peer-review

47 Scopus citations

Abstract

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 drugidrug 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 morphineiclopidogrel 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.

Original language	English (US)
Pages (from-to)	201-208
Number of pages	8
Journal	International Journal of Cardiology
Volume	215
DOIs	https://doi.org/10.1016/j.ijcard.2016.04.077
State	Published - Jul 15 2016

Keywords

Clopidogrel
Drug-drug interaction
Morphine
Prasugrel
Ticagrelor

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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10.1016/j.ijcard.2016.04.077

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title = "Impact of morphine on antiplatelet effects of oral P2Y12 receptor inhibitors",

abstract = "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 drugidrug 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 morphineiclopidogrel 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.",

keywords = "Clopidogrel, Drug-drug interaction, Morphine, Prasugrel, Ticagrelor",

author = "Jacek Kubica and Aldona Kubica and Bernd Jilma and Piotr Adamski and Hobl, {Eva Luise} and Navarese, {Eliano Pio} and Siller-Matula, {Jolanta Maria} and Anita D{\c a}browska and Tomasz Fabiszak and Marek Kozi{\'n}ski and Gurbel, {Paul Alfred}",

note = "Publisher Copyright: {\textcopyright} 2016 The Authors. Published by Elsevier Ireland Ltd.",

year = "2016",

month = jul,

day = "15",

doi = "10.1016/j.ijcard.2016.04.077",

language = "English (US)",

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AU - Kubica, Jacek

AU - Kubica, Aldona

AU - Jilma, Bernd

AU - Adamski, Piotr

AU - Hobl, Eva Luise

AU - Navarese, Eliano Pio

AU - Siller-Matula, Jolanta Maria

AU - Dąbrowska, Anita

AU - Fabiszak, Tomasz

AU - Koziński, Marek

AU - Gurbel, Paul Alfred

PY - 2016/7/15

Y1 - 2016/7/15

N2 - 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 drugidrug 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 morphineiclopidogrel 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.

AB - 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 drugidrug 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 morphineiclopidogrel 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.

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KW - Prasugrel

KW - Ticagrelor

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Impact of morphine on antiplatelet effects of oral P2Y12 receptor inhibitors

Abstract

Keywords

ASJC Scopus subject areas

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