Use of Clopidogrel and Proton Pump Inhibitors Alone or in Combinations in Persons with Diabetes in Denmark; Potential for CYP2C19 Genotype-Guided Drug Therapy

dkAbstract:Background: Clopidogrel and proton pump inhibitors (PPIs) are among the most useddrugs in Denmark for which there exists pharmacogenomics (PGx)-based dosing guidelines and FDAannotations. In this study, we further scrutinized the use of clopidogrel and PPIs when prescriptionswere redeemed from Danish Pharmacies alone or in combination in the Danish population andamong persons with diabetes in Denmark. The focus deals with the potential of applying PGx-guided antiplatelet therapy taking both drug–drug interactions (DDI) and drug–gene interactions(DGI) into account. Methods: The Danish Register of Medicinal Product Statistics was the source toretrieve consumption data. Results: The consumption of PPIs and clopidogrel in terms of prevalence(users/1000 inhabitants) increased over a five-year period by 6.3% to 103.1 (PPIs) and by 41.7% to22.1 (clopidogrel), respectively. The prevalence of the use of clopidogrel and PPIs in persons withdiabetes are 3.8 and 2.1–2.8 times higher compared to the general population. When redeemedin combination, the prevalence increased to 4.7. The most used combination was clopidogrel andpantoprazole. Conclusions: The use of clopidogrel and PPIs either alone or in combination is quitewidespread, in particular among the elderly and persons with diabetes. This further supports theemerging need of accessing and accounting for not only DDI but also for applying PGx-guided drugtherapy in clinical decision making for antiplatelet therapy with clopidogrel having a particular focuson persons with diabetes and the elderly.