What are some common drug interactions with proton pump inhibitors?

1.

Elsevier ClinicalKey Drug Monograph

Content last updated: January 4, 2024.

Interactions Alti-Cefuroxime: (Major) Avoid the concomitant use of proton pump inhibitors (PPIs) and Alti-Cefuroxime. Drugs that reduce gastric acidity, such as PPIs, can interfere with the oral absorption of Alti-Cefuroxime axetil and may result in reduced antibiotic efficacy.

Interactions Cefuroxime: (Major) Avoid the concomitant use of proton pump inhibitors (PPIs) and cefuroxime. Drugs that reduce gastric acidity, such as PPIs, can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy.

2.

Proton Pump Inhibitors (PPIs), Elsevier ClinicalKey Drug Class Overview

Content last updated: April 5, 2023.

PPIs have been found to decrease the absorption of some antiretroviral drugs. Concurrent use of PPIs and rilpivirine is contraindicated; when these drugs are coadministered, there is a potential for treatment failure and/or the development of rilpivirine or NNRTI resistance[44376]. PPIs can decrease the absorption of atazanavir, delavirdine, and nelfinavir, secondary to increased intragastric pH. Omeprazole has been reported to decrease the oral bioavailability of indinavir[26513]. Reductions in the availability of antiretroviral agents may lead to therapeutic failure and HIV resistance development; thus, avoid coadministration of PPIs with these antiretroviral drugs[48857]. [48858] [48859] Additionally, if saquinavir must be administered with a PPI, closely monitor the patient for saquinavir-related toxicities, including gastrointestinal symptoms, increased triglycerides, deep vein thrombosis (DVT), and QT prolongation, as the AUC of saquinavir is greatly increased by omeprazole and is expected to increase with other PPIs[28995]. [33101]

Because PPIs increase intragastric pH, the absorption of drugs that require an acidic environment for absorption may be reduced. Some examples include ampicillin, itraconazole, ketoconazole, iron salts, dasatinib, and cyanocobalamin. This list is not inclusive of all drugs that require an acidic environment for absorption[23614]. [48800] [48801] [48803] [48804] [48854] [48856]

Omeprazole and esomeprazole reduce the conversion of clopidogrel to its active metabolite via inhibition of CYP2C19 leading to decreased antiplatelet activity. Consider use of another PPI with minimal or no impact on CYP2C19, such as rabeprazole, pantoprazole, lansoprazole, or dexlansoprazole if a PPI is necessary for a patient receiving clopidogrel. In clinical studies, the use of omeprazole significantly reduced the antiplatelet activity of clopidogrel when administered concomitantly or 12 hours apart. Concurrent administration of esomeprazole with clopidogrel led to similar reductions in antiplatelet activity. Conversely, coadministration of rabeprazole, pantoprazole, lansoprazole, or dexlansoprazole with clopidogrel did not result in a clinically significant reduction in exposure to the active metabolite of clopidogrel or clopidogrel-induced platelet inhibition[28435]. [29486] [29524] [29564] [40029] [40337] [40596]

PPIs only inhibit actively secreting H+ pumps; thus, concomitant administration with antisecretory agents, such as antimuscarinics, octreotide, and misoprostol, will decrease the effectiveness of PPI therapy[48860].

3.

Food and Drug Administration (DailyMed).

Publish date: September 4, 2016.

Drug Interactions 7.DRUG INTERACTIONS 7.1 Interference with Antiretroviral Therapy Concomitant use of atazanavir and nelfinavir with proton pump inhibitors is not recommended. Coadministration of atazanavir with proton pump inhibitors is expected to substantially decrease atazanavir plasma concentrations and may result in a loss of therapeutic effect and the development of drug resistance. Coadministration of saquinavir with proton pump inhibitors is expected to increase saquinavir concentrations, which may increase toxicity and require dose reduction. Omeprazole, of which esomeprazole is an enantiomer, has been reported to interact with some antiretroviral drugs. The clinical importance and the mechanisms behind these interactions are not always known. Increased gastric pH during omeprazole treatment may change the absorption of the antiretroviral drug. Other possible interaction mechanisms are via CYP2C19. Reduced concentrations of atazanavir and nelfinavir For some antiretroviral drugs, such as atazanavir and nelfinavir, decreased serum levels have been reported when given together with omeprazole. Following multiple doses of nelfinavir (1250 mg, twice daily) and omeprazole (40 mg daily), AUC was decreased by 36% and 92%, C max by 37% and 89% and C min by 39% and 75%, respectively for nelfinavir and M8. Following multiple doses of atazanavir (400 mg, daily) and omeprazole (40 mg, daily, 2 hr before atazanavir), AUC was decreased by 94%, C max by 96%, and C min by 95%. Concomitant administration with omeprazole and drugs such as atazanavir and nelfinavir is therefore not recommended.

4.

Food and Drug Administration (DailyMed).

Publish date: March 2, 2024.

Drug Interactions 7 DRUG INTERACTIONS Table 3 and Table 4 include drugs with clinically important drug interactions and interaction with diagnostics when administered concomitantly with omeprazole and instructions for preventing or managing them. Consult the labeling of concomitantly used drugs to obtain further information about interactions with PPIs. Table 3: Clinically Relevant Interactions Affecting Drugs Co-Administered with Omeprazole and Interaction with Diagnostics Antiretrovirals Clinical Impact: The effect of PPIs on antiretroviral drugs is variable. The clinical importance and the mechanisms behind these interactions are not always known. • Decreased exposure of some antiretroviral drugs (e.g., rilpivirine, atazanavir and nelfinavir) when used concomitantly with omeprazole may reduce antiviral effect and promote the development of drug resistance [see Clinical Pharmacology ( 12.3 )]. • Increased exposure of other antiretroviral drugs (e.g., saquinavir) when used concomitantly with omeprazole may increase toxicity [see Clinical Pharmacology ( 12.3 )]. • There are other antiretroviral drugs which do not result in clinically relevant interactions with omeprazole. Intervention: Rilpivirine-containing products : Concomitant use with Prilosec (omeprazole magnesium) is contraindicated [see Contraindications ( 4 )]. Atazanavir : Avoid concomitant use with Prilosec (omeprazole magnesium). See prescribing information for atazanavir for dosing information. Nelfinavir : Avoid concomitant use with Prilosec (omeprazole magnesium). See prescribing information for nelfinavir. Saquinavir : See the prescribing information for saquinavir for monitoring of potential saquinavir-related toxicities. Other antiretrovirals : See prescribing information for specific antiretroviral drugs. Warfarin Clinical Impact: Increased INR and prothrombin time in patients receiving PPIs, including omeprazole, and warfarin concomitantly.

5.

Food and Drug Administration (DailyMed).

Publish date: August 6, 2020.

Drug Interactions 7. DRUG INTERACTIONS Tables 3 and 4 include drugs with clinically important drug interactions and interaction with diagnostics when administered concomitantly with Omeprazole delayed-release capsules and instructions for preventing or managing them. Consult the labeling of concomitantly used drugs to obtain further information about interactions with PPIs. Table 3: Clinically Relevant Interactions Affecting Drugs Co-Administered with Omeprazole Delayed-release Capsules and Interaction with Diagnostics Antiretrovirals Clinical Impact: The effect of PPIs on antiretroviral drugs is variable. The clinical importance and the mechanisms behind these interactions are not always known. • Decreased exposure of some antiretroviral drugs (e.g., rilpivirine, atazanavir and nelfinavir) when used concomitantly with omeprazole may reduce antiviral effect and promote the development of drug resistance [see Clinical Pharmacology (12.3) ] . • Increased exposure of other antiretroviral drugs (e.g., saquinavir) when used concomitantly with omeprazole may increase toxicity [see Clinical Pharmacology (12.3) ] . • There are other antiretroviral drugs which do not result in clinically relevant interactions with omeprazole. Intervention: Rilpivirine-containing products : Concomitant use with Omeprazole delayed-release capsules are contraindicated [see Contraindications (4) ]. Atazanavir : Avoid concomitant use with Omeprazole delayed-release capsules. See prescribing information for atazanavir for dosing information. Nelfinavir : Avoid concomitant use with Omeprazole delayed-release capsules. See prescribing information for nelfinavir. Saquinavir : See the prescribing information for saquinavir for monitoring of potential saquinavir-related toxicities. Other antiretrovirals : See prescribing information for specific antiretroviral drugs. Warfarin Clinical Impact: Increased INR and prothrombin time in patients receiving PPIs, including omeprazole, and warfarin concomitantly.