Esomeprazole and Rilpivirine: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Rilpivirine
Esomeprazole
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 oral rilpivirine exposure, reduced efficacy of rilpivirine and an increased loss of virologic response
Interaction Deep Dive
Concomitant use of oral rilpivirine or rilpivirine-containing products with proton pump inhibitors is contraindicated. Proton pump inhibitors increases gastric pH and concurrent administration with oral rilpivirine may reduce rilpivirine absorption, resulting in reduced rilpivirine plasma concentrations, loss of virologic response and possible resistance development1234.
Why it happens (mechanism)
Reduced absorption of oral rilpivirine due to increased gastric pH caused by proton pump inhibitors
Literature reports
2 reports — tap to read
a) In drug interaction studies, the concomitant administration of omeprazole and rilpivirine in healthy subjects or in patients with antiretroviral treatment-naive HIV-1 resulted in a significant decrease in rilpivirine AUC, Cmax, and Cmin. Patients received once daily doses of omeprazole 20 mg and rilpivirine 150 mg. The ratio (omeprazole plus rilpivirine/rilpivirine alone) estimate for rilpivirine was 0.6 (90% CI, 0.51 to 0.71) for AUC, 0.6 (90% CI, 0.48 to 0.73) for Cmax, and 0.67 (90% CI, 0.58 to 0.78) for Cmin 23.
b) Following multiple doses of rilpivirine (150 mg daily) and omeprazole (20 mg daily), AUC was decreased by 40%, Cmax by 40%, and Cmin by 33% for rilpivirine 4.
Common questions
Can I take Esomeprazole and Rilpivirine together?
Reduced oral rilpivirine exposure, reduced efficacy of rilpivirine and an increased loss of virologic response Always confirm with your pharmacist or prescriber before making any change.
How serious is the Esomeprazole and Rilpivirine interaction?
It is rated contraindicated. These should generally not be used together.
How quickly could this interaction happen?
The documented onset is "delayed". Effects tend to build up gradually over days to weeks.
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 Rilpivirine 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 (4)
- Product Information: JULUCA oral tablets, dolutegravir rilpivirine oral tablets. ViiV Healthcare (per FDA), Research Triangle Park, NC, 2022. DailyMed
- Product Information: EDURANT(R) oral tablets, rilpivirine oral tablets. Janssen Therapeutics (per FDA), Horsham, Pa, 2024. DailyMed
- Product Information: EDURANT(R) PED oral tablets for suspension, rilpivirine oral tablets for suspension. Janssen Therapeutics (per FDA), Horsham, Pa, 2024. DailyMed
- Product Information: KONVOMEP(TM) powder for oral suspension, omeprazole sodium bicarbonate powder for oral suspension. Azurity Pharmaceuticals Inc (per manufacturer), Woburn, MA, 2022. DailyMed
Keep reading about Rilpivirine
Keep reading about Esomeprazole
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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