Cardio Notes: Morphine Weakens Clopidogrel
Published: Dec 9, 2013
The recommended pain medication for patients with myocardial infarction may interfere with clopidogrel, and a new effort targets readmissions.
Morphine Gets in the Way of Clopidogrel
When morphine and clopidogrel were administered at the same time, the antiplatelet didn't work as well, potentially explaining the previously observed association between morphine and increased mortality in patients with non-ST-segment elevation acute coronary syndrome.
In a randomized, crossover trial, Bernd Jilma, MD, of the Medical University of Vienna, and colleagues gave 24 healthy individuals a 600-mg loading dose of clopidogrel followed by either placebo or 5 mg of morphine. The presence of morphine delayed resorption of clopidogrel, reduced plasma levels of its active metabolite to levels typically seen in intermediate or poor metabolizers, and impaired platelet inhibition.
"Co-administration of morphine and clopidogrel should likely be avoided, if possible," the researchers wrote in the Journal of the American College of Cardiology. "More potent P2Y12 inhibitors may provide greater efficacy when morphine is injected, but their interaction with morphine should be evaluated in further trials."
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