Esomeprazole Injection and Fluconazole: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Fluconazole
Esomeprazole Injection
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Increased esomeprazole plasma concentrations
Interaction Deep Dive
Due to inhibition of CYP2C19- and CYP3A4-mediated esomeprazole metabolism, esomeprazole exposure may increase by more than 2-fold when administered concurrently with fluconazole. Although dose adjustment is not required, in patients being treated with high doses (up to 240 mg/day orally) of esomeprazole for Zollinger-Ellison's syndrome, dose adjustments may be considered1. Fluconazole-mediated enzyme inhibition may persist for 4 to 5 days after discontinuation. If concomitant use is required, carefully monitor for esomeprazole-associated adverse effects 2.
Why it happens (mechanism)
Inhibition of CYP2C19- and CYP3A4-mediated esomeprazole metabolism by fluconazole
Common questions
Can I take Esomeprazole Injection and Fluconazole together?
Increased esomeprazole plasma concentrations Always confirm with your pharmacist or prescriber before making any change.
How serious is the Esomeprazole Injection and Fluconazole interaction?
It is rated moderate. Can be significant — usually manageable with monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Esomeprazole Injection or Fluconazole need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there anything you'd monitor while I'm on both?
References (2)
- Product Information: NEXIUM(R) oral delayed-release capsules, oral delayed-release suspension, esomeprazole magnesium oral delayed-release capsules, oral delayed-release suspension. AstraZeneca LP (per FDA), Wilmington, DE, 2014. DailyMed
- Product Information: DIFLUCAN(R) oral tablets, oral suspension, fluconazole oral tablets, oral suspension. Roerig (per FDA), New York, NY, 2014. DailyMed
Keep reading about Fluconazole
Keep reading about Esomeprazole Injection
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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