Esomeprazole with Posaconazole Interaction Details
Brand Names Associated with Esomeprazole
- Esomeprazole
- Nexium®
- Nexium® 24HR
- Vimovo® (as a combination product containing Esomeprazole, Naproxen)
Brand Names Associated with Posaconazole
- Noxafil PowderMix®
- Noxafil®
- Posaconazole
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 08, 2023
Interaction Effect
Decreased posaconazole plasma levels
Interaction Summary
Concomitant use of esomeprazole and posaconazole oral suspension may decrease posaconazole serum concentrations. In 12 healthy subjects, the concurrent administration of posaconazole oral suspension 400 mg as a single dose with esomeprazole 40 mg daily for 3 days reduced posaconazole mean Cmax and AUC by 46% and 32%, respectively, when compared with use of posaconazole oral suspension alone. However, clinically relevant effects on Cmax and AUC were not observed with concomitant use of esomeprazole and posaconazole delayed-release tablets. Avoid concurrent use of esomeprazole with posaconazole oral suspension unless potential benefits outweigh the risks, but if such use is required, monitor patients closely for continued antifungal efficacy .
Severity
Major
Onset
Delayed
Evidence
Established
How To Manage Interaction
Avoid concurrent use of esomeprazole and posaconazole oral suspension unless the potential benefit outweighs the risk, as coadministration may result in decreased exposure to posaconazole. If concomitant use is required, monitor the patient closely for continued antifungal efficacy. No clinically relevant effects were observed with concomitant use of proton pump inhibitors and posaconazole delayed-release tablets.
Mechanism Of Interaction
Decreased bioavailability of posaconazole with increase in gastric pH
Literature Reports
A) Concomitant use of esomeprazole and posaconazole may decrease posaconazole serum concentrations. In a phase 1, randomized, crossover study to evaluate differences in posaconazole absorption with decreased gastric pH, 12 healthy subjects were administered 4 different treatment regimens: (1) a single 400 mg dose of posaconazole while fasting (2) a single 400 mg dose of posaconazole and an acidic carbonated beverage (ginger ale) while fasting, (3) esomeprazole 40 mg daily for 3 days with scheduled meals permitted on days 1 and 2 and on day 3 administration of a single 400 mg dose of posaconazole while fasting, and (4) esomeprazole 40 mg daily for 3 days with scheduled meals permitted on days 1 and 2 and on day 3 administration of a single 400 mg dose of posaconazole with an acidic carbonated beverage while fasting. Compared with results achieved with a single 400 mg dose of posaconazole given alone under fasting conditions, coadministration of esomeprazole elicited reductions in posaconazole mean Cmax and AUC by 46% and 32%, respectively. Administration of posaconazole, an acidic carbonated beverage and esomeprazole together, elicited reductions in the mean posaconazole Cmax and AUC by 33% and 21%, respectively .
Esomeprazole Overview
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Prescription esomeprazole is used to treat the symptoms of gastroesophageal reflux disease (GERD), a condition in which backward flow of acid from the stomach causes heartburn and possible injury of the esophagus (the tube between the throat and stomach) in adults and children 1 year of age and older. Prescription esomeprazole is used to treat damage from GERD in adults and children 1 month of age and older. Prescription esomeprazole is used to allow the esophagus to heal and prevent further damage to the esophagus in adults with GERD. Prescription esomeprazole is also used to decrease the chance that people who are taking nonsteroidal anti-inflammatory drugs (NSAIDs) will develop ulcers (sores in the lining of the stomach or intestine) in adults. It is also used with other medications to treat and prevent the return of stomach ulcers caused by a certain type of bacteria (H. pylori) in adults. Prescription esomeprazole is also used to treat conditions in which the stomach produces too much acid such as Zollinger-Ellison syndrome in adults. Nonprescription (over-the-counter) esomeprazole is used to treat frequent heartburn (heartburn that occurs at least 2 or more days a week) in adults. Esomeprazole is in a class of medications called proton pump inhibitors. It works by decreasing the amount of acid made in the stomach.
Posaconazole Overview
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Posaconazole is used to prevent serious fungal infections that can spread throughout the body in adults and children 2 years of age and older with a weakened ability to fight infection. Posaconazole delayed-release tablets are used to treat invasive aspergillosis (a serious fungal infection that begins in the lungs and spreads through the bloodstream to other organs) in adults and teenagers 13 years of age and older. Posaconazole oral suspension is also used to treat yeast infections of the mouth and throat including yeast infections in adults and teenagers 13 years of age and older that could not be treated successfully with other medications. Posaconazole is in a class of medications called azole antifungals. It works by slowing the growth of fungi that cause infection.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.