Esopump Drug Interactions

Effect of Esomeprazole on pharmacokinetics of the other drugs: The gastric acid suppression during treatment with Esomeprazole i.v. and other PPIs, may decrease or increase the absorption of drugs with a gastric pH dependent absorption. Like with other drugs that decrease the intragastric acidity, the absorption of drugs such as Ketoconazole, Itraconazole and Erlotinib can decrease while the absorption of Digoxin can increase during treatment with Esomeprazole. Concomitant treatment with Omeprazole (20 mg daily) and Digoxin in healthy subjects increased the bioavailability of Digoxin.
Esomeprazole inhibits CYP2C19, the major Esomeprazole enzyme metabolism. Concomitant oral administration of 30 mg Esomeprazole resulted in decreasing clearance of the CYP2C19 substrate Diazepam. This interaction is unlikely to be of clinical relevance. Concomitant oral administration of 40 mg Esomeprazole resulted in increasing trough plasma levels of Phenytoin in epileptic patients. Concomitant oral administration of 40 mg Esomeprazole to Warfarin-treated patients showed that, despite a slight elevation in the trough plasma concentration of the less potent than R-isomer of Warfarin, the coagulation times were within the accepted range.
Pharmacokinetic/pharmacodynamic interaction between Clopidogrel (300 mg loading dose/75 mg daily maintenance dose) and Esomeprazole (40 mg p.o. daily) resulting in decreased exposure to the active metabolite of Clopidogrel and resulting in decreased maximum inhibition of (ADP induced) platelet aggregation.
When given together with proton pump inhibitors, Methotrexate levels have been reported to increase in some patients. In high-dose Methotrexate administration a temporary withdrawal of Esomeprazole may need to be considered.
Omeprazole has been reported to interact with some antiretroviral drugs. Increased gastric pH during Omeprazole treatment may change the absorption of the antiretroviral drug. Other possible interaction mechanisms are via CYP2C19. For some antiretroviral drugs, such as Atazanavir and Nelfinavir, decreased serum levels have been reported when given together with Omeprazole and concomitant administration are not recommended. For other antiretroviral drugs, such as Saquinavir, increased serum levels have been reported. There are also some antiretroviral drugs for which unchanged serum levels have been reported when given with Omeprazole. Due to the similar pharmacodynamic effects and pharmacokinetic properties of Omeprazole and Esomeprazole, concomitant administration with Esomeprazole and antiretroviral drugs such as Atazanavir and Nelfinavir is not recommended (see Contraindications).
Esomeprazole has been shown to have no clinically relevant effects on the pharmacokinetics of Amoxicillin or Quinidine.
Effect of other drugs on pharmacokinetics of Esomeprazole: Esomeprazole is metabolised by CYP2C19 and CYP3A4. Concomitant oral administration of Esomeprazole and a CYP3A4 inhibitor, Clarithromycin (500 mg b.i.d.), resulted in a doubling of the exposure (AUC) to Esomeprazole. Concomitant administration of Esomeprazole and a combined inhibitor of CYP2C19 and CYP3A41, such as Voriconazole, may result in more than doubling of the Esomeprazole exposure. The CYP2C19 and CYP3A4 inhibitor Voriconazole increased Omeprazole AUC_T. A dose adjustment of Esomeprazole is not regularly required in either of these situation. However, dose adjustment should be considered in patients with severe hepatic impairment and if long-term treatment is indicated.
Drugs known to induce CYP2C19 or CYP3A4 or both (such as Rifampicin and St. John's wort) may lead to descrease Esomeprazole serum levels by increasing the Esomeprazole metabolism.