From the Guidelines
Felodipine is an appropriate medication for patients with hypertension and can be used concomitantly with Proton Pump Inhibitors (PPIs) if necessary, as there are no significant interactions between felodipine and PPIs that would affect morbidity, mortality, or quality of life. When considering the use of felodipine in patients taking PPIs, it's essential to focus on the management of hypertension and the potential effects of felodipine on blood pressure control. According to the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1, felodipine is listed as a dihydropyridine calcium channel blocker that can be used to treat hypertension. The key considerations in using felodipine include:
- Monitoring for dose-related pedal edema, which is more common in women than men
- Avoiding use in patients with heart failure with reduced ejection fraction (HFrEF) unless required
- Potential interactions with other medications, although there is no specific mention of interactions with PPIs in the provided evidence It's also important to note that felodipine and PPIs have different mechanisms of action and are used to treat different conditions. Felodipine is used to treat hypertension, while PPIs are used to suppress acid production in the stomach. In patients with comorbidities such as hypertension and acid-related disorders, the use of felodipine and a PPI may be necessary to manage both conditions effectively. However, it's crucial to carefully evaluate the patient's individual needs and potential interactions between medications, as outlined in the statement from the American Heart Association on the contributory risk and management of comorbidities of hypertension, obesity, diabetes mellitus, hyperlipidemia, and metabolic syndrome in chronic heart failure 1. Ultimately, the decision to use felodipine in patients taking PPIs should be based on a thorough assessment of the patient's medical history, current medications, and potential risks and benefits, with the goal of optimizing blood pressure control and minimizing adverse effects.
From the Research
Drug Interactions with Proton Pump Inhibitors (PPIs)
- Proton pump inhibitors (PPIs) are known to have various drug interactions, including those with anti-infective agents, anticancer drugs, antiplatelet agents, and anticoagulants, as well as antidiabetics 2.
- The clinical relevance of these interactions remains controversial, but clinicians should be vigilant for interactions that may require dose adjustment or therapeutic monitoring 2.
- Not all PPIs have the same pharmacokinetic and pharmacodynamic profile, with some having a strong potential to inhibit CYP2C19, such as omeprazole, esomeprazole, and lansoprazole, while others, pantoprazole, rabeprazole, and dexlansoprazole, are weak CYP2C19 inhibitors 2.
Felodipine and PPI Interactions
- There is no direct evidence in the provided studies regarding the interaction between Felodipine, a calcium channel blocker, and Proton Pump Inhibitors (PPIs).
- However, it is known that PPIs can interact with various medications, and their use should be carefully evaluated, especially in patients with multiple comorbidities and polypharmacy 3, 4.
General Considerations for PPI Use
- PPIs are valuable medications for the prevention and treatment of certain disorders, but their excessive and inappropriately prolonged use is associated with a broad range of adverse effects 5, 3.
- Education of providers and patients, stewardship, and motivation are key to the appropriate use of PPIs for the right indications 5.
- The potential for drug-drug interactions, including those with anticancer agents, should be considered when prescribing PPIs, especially in patients with cancer 6.