Esomeprazole and Nilotinib: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Nilotinib
No brand names on recordEsomeprazole
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
Reduced nilotinib exposure and reduced efficacy of nilotinib
Interaction Deep Dive
Avoid concomitant use of a proton pump inhibitor (PPI) with nilotinib may as it may reduce nilotinib exposure resulting in reduced efficacy of nilotinib. Use an alternative to PPIs, such as histamine-2 receptor antagonist (H2RA) given approximately 10 hours before or 2 hours after the dose of nilotinib, or use antacids about 2 hours before or 2 hours after the dose of nilotinib. In a study, coadministration of nilotinib with multiple esomeprazole 40 mg daily doses resulted in a 34% reduction in nilotinib AUC12. However, no significant change in the efficacy of nilotinib was observed with concurrent administration of a PPI or H2 blocker for any duration compared with patients with no PPI or H2 blocker use during a retrospective review of 2 clinical trials (n=748) in patients with Philadelphia chromosome-positive chronic myeloid leukemia in chronic phase 3.
Why it happens (mechanism)
Reduction in nilotinib bioavailability due to decreased solubility and absorption of nilotinib due to increased pH of the upper gastrointestinal tract caused by proton pump inhibitors
Literature reports
3 reports — tap to read
a) in a drug interaction study, coadministration of multiple doses of esomeprazole 40 mg daily decreased the nilotinib AUC by 34% 12.
b) Major molecular response (MMR) rates at 12 months were not affected by concurrent administration of proton pump inhibitors (PPI) or H2 blockers with nilotinib, according to a retrospective analysis of patients with newly diagnosed Philadelphia chromosome-positive chronic myelogenous leukemia in chronic phase enrolled in a phase 3 study (n=492). PPIs included esomeprazole, lansoprazole, omeprazole, pantoprazole, and RABEprazole; H2 blockers included cimetidine, famotidine, and raNITIdine. MMR at 12 months was achieved in 49.6% (59 of 119) of patients who received nilotinib and a PPI or H2 blocker for any duration compared with 41% (153 of 373) of patients who did not receive any PPI or H2 blocker (p=0.13). Median duration of concurrent use was 137 days for PPIs and 33 days for H2 blockers while on nilotinib therapy, with 9.3% (46 of 492) of patients receiving concurrent therapy for more than 50% of the study period 3.
c) Major cytogenic response (MCyR) and complete cytogenic response (CCyR) rates at 12 months were not affected by concurrent administration of proton pump inhibitors (PPI) or H2 blockers with nilotinib, according to a retrospective analysis of imatinib-experienced patients with Philadelphia chromosome-positive chronic myelogenous leukemia in chronic phase enrolled in a phase 2 study (n=256). PPIs included esomeprazole, lansoprazole, omeprazole, pantoprazole, and RABEprazole; H2 blockers included cimetidine, famotidine, and raNITIdine. MCyR at 12 months was achieved in 64% (55 of 86) of patients who received nilotinib and a PPI or H2 blocker for any duration compared with 57.6% (98 of 170) of patients who did not receive any PPI or H2 blocker (p=0.4), and CCyR at 12 months was achieved in 45.3% (39 of 86) and 38.2% (65 of 170) of patients (p=0.34), respectively. Median duration of concurrent use was 177 days for PPIs and 96 days for H2 blockers while on nilotinib therapy, with 23% (59 of 256) of patients receiving concurrent therapy for more than 50% of the study period 3.
Common questions
Can I take Esomeprazole and Nilotinib together?
Reduced nilotinib exposure and reduced efficacy of nilotinib Always confirm with your pharmacist or prescriber before making any change.
How serious is the Esomeprazole and Nilotinib interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "rapid". Effects can appear quickly, often within about 24 hours of combining the drugs.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Esomeprazole or Nilotinib 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 a safer alternative to one of these medications for me?
References (3)
- Product Information: TASIGNA(R) oral capsules, nilotinib oral capsules. Novartis Pharmaceuticals Corporation (per FDA), East Hanover, NJ, 2024. DailyMed
- Product Information: DANZITEN oral tablets, nilotinib oral tablets. Azurity Pharmaceuticals, Inc. (per FDA), Woburn, MA, 2024. DailyMed
- Yin OQ, Giles FJ, Baccarani M, et al: Concurrent use of proton pump inhibitors or H2 blockers did not adversely affect nilotinib efficacy in patients with chronic myeloid leukemia. Cancer Chemother Pharmacol 2012; 70(2):345-350. PubMed
Keep reading about Nilotinib
Keep reading about Esomeprazole
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