Clopidogrel and lansoprazole

[sobs1962]

Have been prescribed clopidogrel and Lansoprazole after having a TIA,just wondered if anyone has any experience with these drugs as,I believe that lansoprazole is a proton pump inhibitor and will prevent absorption of Levothyroxine due to lowering stomach acid, something that is already low in those with hypothyroidism . Any words of wisdom gratefully received as I have been put on clopidogrel as an alternative to high dose aspirin abut can cause stomach problems including ulcer.

[shaws Administrator]

I'm sorry you are having other symptoms but this is a link that might be helpful for you:-

nhs.uk/conditions/transient...

[sobs1962 in reply to shaws]

Thanks for that but luckily, they've explained to me that my right carotid artery was blocked, which is why I've had the surgery to unblock it and I guess when it comes to the medication I've been prescribed, I guess unlessI want to have another worse stroke, I really have no choice but to take it, including atorvastatin, which is apparently a big no-no for people with hypothyroidism as hypothyroidism causes high cholesterol and they won't see my thyroid as a priority irrespective of what my quality of life is like. The last 10 days have been absolute hell and to a certain degree, I feel like I'm a guinea pig being used to test how bad or otherwise the side effects of these drugs are. Even if you do tell them you're having quite severe side effects, they just seem to shrug it off as if it's nothing, I bet none of these doctors would take these drugs voluntarily as they know how dangerous they can be. Obviously hoping my quality of life will improve but I simply don't think that doctors consider it be important and if lansoprazole is blocking the absorption of Levothyroxine,then it stands to reason, that I will feel worse as time goes on. We are dealing with a whole generation of doctors who are ignorant of the facts about hypothyroidism, let's just hope that someone educates them and very soon, or there will be thousands of very unwell people in the UK, for a long time to come.

[nellie237 in reply to sobs1962]

Hi sobs,

I'm so sorry that you are going through this horrendous time .

I think its really hard to tell what the side effects are when you have an event and get sent home with a sack full of meds. You feel rubbish anyway, and a bit scared too at first which doesn't help. It does get better, once you start going for walks and taking a bit of exercise your confidence in your health improves.

Clopidogrel

I was on clopidogrel for just a year (which is the norm after stenting) after a heart attack in 2012. I think with TIA they keep you on it? The only side effect I noticed was I'd get small bruises on my hands/legs/arms (not all the time, but certainly more often than usual) and tbh I didn't really notice until I stopped taking them, but I was already on lansoprazole.

Atorvastatin

I was prescribed 80mg Atorvastatin in 2012 - they are huge, like trying to swallow a boulder. I took the 80mg for a few months, then insisted on dropping to 40mg. I didn't know then that us Hypo's are at slightly more risk for rhabdomyolysis, but my GP did check my creatine kinase. I think once you've had an event the decision on taking statins is very personal. The benefit is small, and it is what it is.

Vitamin C is very beneficial for your arteries.

Lansoprazole

I was prescribed 30mg Lansoprazole for Hiatus Hernia before I was dx Hashi's (2007). , and this was increased to 60mg at some point. I only found this forum last year, after a coeliac dx. I dropped down to 30mg Lansoprazole in Jan 2021 and came off them completely in March 2021, although I re-started a couple of weeks ago (turns out I have a UTI, and I when this resolves I will try and stop them again) but I'm not taking clopidogrel, although I do take blood pressure meds that are not gut friendly, as well as low dose aspirin.

As far as your thyroid goes, I think your only option is to give yourself a few weeks for your body to adjust and get TFT's to see where you sit.

[sobs1962 in reply to nellie237]

That's a lot easier said than done, it seems that my GP practice have an aversion to doing blood tests and when they do TFTs, they only ever do TSHand Ft4, never ft3, so unless I pay to have them done they'll probably wait a full 12 months since the last lot so October 2022 but really need to talk to them about interaction between clopidogrel and lansoprazole.

[sobs1962 in reply to nellie237]

Thanks for reply but if the benefits of taking a statin are so small, what is the point compared to the risk of serious side effects, already had pancreatic pain in the fast couple of days of taking them.

[nellie237 in reply to sobs1962]

Hi sobs,

I don't think anybody can really answer that because we are all different. We know they inflated/out-right lied about the benefits of statins so much that I don't trust any information. Kudos to the Nordic Cochrane Collaboration.

I've been reducing my statins, and will be off them completely in a couple of weeks, but I wouldn't recommend anybody else to do the same . As far as I'm aware I haven't had any side effects.

One of the problems I found when trying to make my decision is that the Consultants/Doctors who publicly disagree with Statins are always talking about people who have not had an 'event'. I did read one paper that gave the benefit as 1.3% for those who hadn't already had a event, to about 3% for those of us that had.

I think the deciding factor for me was watching a British Heart Foundation video on Statins, (because you've got to look at both sides of the argument) and was shocked to discover it was presented by Prof Rory Collins. I'd best not say anymore.

[sobs1962 in reply to nellie237]

Have watched BHF presentation and it's blatantly obvious to me that Prof Collins is in cahoots with the pharmaceutical companies and probably has,major shares in these companies and is probably making substantial amounts of money, through that. Having read The Great Cholesterol Con and digested it and what it says about the benefits of statins especially in women, I feel that I would prefer to risk not taking statins and avoid the terrible side effects than risk getting rhabdomyolysis, as us hypos are at much higher risk of that than others without hypothyroidism. I'm sick of all the scaremongering going on and in the book the Great Cholesterol Con, it says that the benefits of statins have been mega-hyped and that there is no scientific evidence that statins benefit women in any way ever. We're all contributing to the trillions of dollars/ pounds in profits these companies are making by being compliant ,as we're too afraid not to be. We arestuck between a rock and a hard place, so we comply,but I'm completely confused by all this information now and my brain needs a rest, especially as I'm trying to recover from a,stroke.

[sobs1962 in reply to nellie237]

The only thing that worries me about doing an at home test, is thatI might not stop bleeding, once I start, as anti platelet medication is designed to stop blood getting sticky and clotting, but trying to get my GP to do blood tests unless (they're due) is a nightmare and I don't need that kind of stress whilst trying to recover from a stroke

[radd]

sobs1962,

I was prescribed both Clopidogrel and Lansoprazole after a recent stroke.

The Lansoprazole I refused because supplement contra-indicated Betaine HCL + pepsin for improved gut absorption regarding low stomach acid.

The Clopidogrel I take because is important in the prevention of further blood clots and appears fine with thyroid meds as long as we are stabilised. Because the level of thyroid hormone can influence the catabolism of clotting factors (ie, a reduction in thyroid hormone meds may decrease anti-coagulation and vice versa) I was advised swopping equipotent thyroid meds is fine (I self-medicate NDT) but if thyroid meds are increased/decreased I must ask GP for a blood test.

It appears Clopidogrel has been associated with an increased risk of gastrointestinal (GI) bleeding so PPI’s are commonly prescribed in combination. However, there are studies saying PPI’s reduce the anti-platelet efficacy of Clopogrel but others showing mixed results. The Food and Drug Administration (FDA) obviously thought the studies credible enough because they issued a Safety Communication regarding Omeprazole reducing the antithrombotic effect of clopidogrel by almost half when taken concomitantly. Omeprazole & Lansoprazole work in slightly different ways but both were shown to effect Clopidogrel efficacy in some people.

I was also prescribed statins that I refused and high BP meds that I take which are reducing as BP is slowly coming back under control.

[sobs1962 in reply to radd]

I'm glad I'm not the only one with aversion to statins and the fact that PPI medication reduces the effect of clopidogrel by up to 50% is very worrying, as I don't want to have another much more serious stroke. Might speak to my GP about it as this sounds like it puts me at a much higher risk of another stroke and I'm not 60 yet.

[radd in reply to sobs1962]

sobs1962,

If you have to take a PPI with Clopidogrel, then Lansoprazole appears to be the safest.

gov.uk/drug-safety-update/c...

'In light of the most recent evidence, the previous advice (to avoid all PPIs unless absolutely necessary for patients taking clopidogrel) is no longer considered necessary. Nevertheless, as a precaution, concomitant use of clopidogrel with omeprazole or esomeprazole should be discouraged. Information for prescribers and patients will be updated with the latest advice.

The current evidence does not support extending this advice to other PPIs. However, because it is not possible to completely exclude a possible interaction with these PPIs on the basis of available data, the potential risk of a slight reduction in efficacy of clopidogrel should be weighed against the potential gastrointestinal benefit of the PPI'.

nhs.uk/medicines/clopidogrel/

[Knip]

I had a Tia in 2016 and was put on Clopidogrel instead of the low dose aspirin I had been taking. I am also on 40mg of Atorvastatin. I have had absolutely no problems with either of these. I take my Thyroxine 125mcg in the mornings half to one hour before having breakfast and my other medications including Clopidogrel. I cannot take stomach protectors because they give me chest pain so I use a high juice lemon squash (50% juice) diluted in water (I find hot water the best) to deal with any acidity, sipping this as required. This was recommended by my RA specialist. Hope you get on well, having a TIA can be quite alarming. x

[Sukeeblue]

Hi I am on lansoprazole for 8 weeks because of a stomache ulcer at the moment plus taking thyroxine. It does not appear to have made a difference to my energy levels etc.

[Miffie]

Hi sobs1962 , sorry you are having a tough time.Try not to worry too much about taking a PPI with thyroid replacement. I have been on Omeprazole for a decade due to HH and Barrett’s oesophagus. I simply could not eat without the PPI. Keep checking your thyroid levels using MMH if your GP is dragging his feet. Our local lab will never do fT3 anyway unless both TSH and fT4 are ‘significantly’ out of range.

I also take a statin due to familial hypercholesterolaemia. Not Atorvastatin as I had too many side effects, we are all different however.

I appreciate you feel very much as if you are a guinea pig testing drugs interaction with thyroid hormones. It may be that for your GP you are, however as hypothyroidism is very common it’s unlikely they have no other patients taking levo plus any other script you have mentioned. I have been on thyroid replacement for sixty years and taken hundreds of other drugs at the same time. Non have caused any significant issues with my thyroid. Currently on treatment for ckd, HH,BO, high blood pressure, FH, T2 diabetes and of course hypothyroidism. Maybe I am just lucky that nothing grim has happened. I don’t want you to think I am flippant about your concerns. Rather trying to put your mind at rest.

PPIs do lower absorption of many drugs/ nutrients however taking levo before your morning PPI will help. I take ndt and levo about 5-6 in the morning and go back to bed. Get up later and start taking everything else.

I now have low iron B12 probably caused by a decade of Omeprazole. Hopefully you will not be affected too much by the new regime.

Take care

[sobs1962 in reply to Miffie]

Thanks for that take,my levo at 6am and no other meds until at least 4 hours after, so if that works and doesn't affect my thyroid negatively, then will carry on doing it.

[Miffie in reply to sobs1962]

Four hours is loads. You don’t need that to take a PPI fortunately as they are usually first thing before food or tea/ coffee.

[sobs1962 in reply to Miffie]

For those with hypothyroidism, PPI medication prevents absorption of Levothyroxine as it reduces stomach acid far too much, so yet another fight I have to have with the doctors involved in my care. I'm exhausted right now and going to have a lie down.

[Miffie in reply to sobs1962]

Sorry sobs1962 I cannot agree with your statement. I take both and in the decade since I was left with no choice but to take PPI daily I have had no significant thyroid problems as a result. I always test regularly and even the GP will do the basic annual. As I previously said I take thyroid replacement well ahead of any other meds especially the PPI and it’s fine.

Low stomach acid has been my norm all my life. I have HH and BO . It’s all about timing for me.

If I did not take a PPI I could not eat.

I have sen a study which advises PPIs do not adversely affect hypothyroidism as long as regular testing is carried out. I will try to find a link to it and post it for you in the hope it puts your mind at rest shortly.

[sobs1962 in reply to Miffie]

Thanks for that

[Miffie in reply to sobs1962]

Sorry I can not find that link. No idea where I saved it to unless it was the shared laptop which had to be cleared after hubby was hacked.

Keep testing!

Good luck going forward.

[sobs1962 in reply to Miffie]

I cannot risk home testing as when on Clopidogrel an anti platelet medication, it's stops blood clotting and I could potentially bleed to death, probably not very likely but possible all the same. Thanks for replying.

[Capella1]

Be careful of any PPI's as it stopped my thyroid med absoption & came off PPi & Levo works better! Many here do not need PPI but docs just give it.

[sobs1962 in reply to Capella1]

Yes, doctors have no clue when it comes to medication interactions, that's why they should always consult a pharmacist, but unfortunately they don't because they think they know it all and unfortunately for us poor patients, they don't.

[Miffie in reply to Capella1]

I rather suspect it depends why the PPI is prescribed as to suitability for those with hypothyroidism. Taking any PPI a good two hours after thyroid replacement works for most of us who have no choice but to take the PPI.

[Capella1 in reply to Miffie]

hi miffie how do you know you need ppi wen low stomach acid level symptoms ar same as high. heartburn can be caused by low

has doctor done a test to check?

[Miffie in reply to Capella1]

Hi, are you having issues? What has your GP thought / decided is the problem. Have you been prescribed a PPI? I assume you have tested stomach acid levels already? Having hypothyroidism makes a person more susceptible to low stomach acid but does not gaurantee it. Or do you think I decided to ask GP and was just given it with no testing at all?

In my case being prescribed a PPI initially resulted from my suffering severe heartburn. No indigestion just heartburn. It finally made me so miserable, missing meals etc and nothing helped my GP decided to try a PPI short term and referred me to gastroenterology for an endoscopy. This showed Hiatus hernia and Barrett’s oesophagus. I was then told it was long term PPI treatment,

My last endoscopy a couple of months ago showed HH and BO still present with gastritis still present. I am still on long term PPI treatment.

I was diagnosed as having hypothyroidism as a child, I did have quite bad heartburn when pregnant but never bad again until just over ten years ago. Then the very severe symptoms began, I had it for most of every day.

I expect every GP has their own way of determining when a PPI trial is needed and will refer patients for an endoscopy to confirm.

I can only comment on my personal experience.

[Capella1 in reply to Miffie]

oh poor you. no issues now tank you but I did had awfuklheart burn during pregnancy & now take betaine coz have low stomach acid.

you no your reasons for high acid. some have it for h. pylori infection, but docs never check for that so I wondered why ppi so often given. thank you

[Gerri030306]

I was prescribed Lanso for heartburn etc, I have Hashimotos. Over time I became under active and very anaemic, all my Vitamins were low. This group helped me to identify that I needed to stop taking it and now after 2 years my Thyroid blood results, iron etc are in optimal range for me. I take a high strength Apple Cider Vinegar which controls the stomach acid.

I feel so much better with the help of this group, you will get the support you need to improve your health. The main thing I got from here is the information to challenge my doctor and consultant with.

[sobs1962 in reply to Gerri030306]

I'm pleased for you, but I'm sooo stressed,I feel like killing myself if the stress,doesn't cause another stroke or heart attack and that kills me.

[Gerri030306 in reply to sobs1962]

Take one issue at a time and work through them. I took up yoga to help me deal with the stress. I discovered how little doctors and consultants know about thyroid, iron etc. You can do it, you can get better.

[sobs1962 in reply to Gerri030306]

I tried yoga but couldn't get into most of the positions as,I have such a stiff jointed body and the fact I failed, just stressed me even more, I expect a massive amount of myself and will never be able to live up to my exalted standards, so that is a constant source of stress for me too.