Drug Interaction Report

Esomeprazole and Sunitinib: Interaction Details

A pharmacist-reviewed analysis of the Esomeprazole and Sunitinib interaction: the documented clinical effects, severity rating, onset, mechanism, and management considerations, with cited references throughout.

AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature

Sunitinib

Sutent Sutent®
+

Esomeprazole

Nexium Nexium® Nexium® 24HR
Dr. Brian Staiger, PharmD, BCPS
Medically reviewed by
Dr. Brian Staiger, PharmD, BCPS
Updated Aug 8, 2026
Editorial policy · Data sources
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Interaction severity
Major
Potentially serious — often needs a change or close monitoring.
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.

Of 106 documented Esomeprazole interactions, 83 are rated major — including this one.
Worried about symptoms right now? Contact your pharmacist or prescriber, or call Poison Control at 1-800-222-1222 (US). Call 911 for an emergency.
Onset
unspecified
Evidence
probable
Severity
Major

What happens

Reduction in sunitinib bioavailability

Interaction Deep Dive

Coadministration of sunitinib with continuous gastric acid suppression by way of a proton pump inhibitor (PPI) may reduce the antitumor efficacy of sunitinib based on reduced overall survival and progression-free survival in a retrospective review of patients with metastatic renal cell cancer. The difference in survival suggests that acid suppressing agents may interact with sunitinib by decreasing sunitinib absorption1.

Why it happens (mechanism)

Decreased solubility and absorption of sunitinib due to increased pH of the upper gastrointestinal tract caused by proton pump inhibitors

Literature reports

1 report — tap to read

a) Coadministration of sunitinib with a proton pump inhibitor (PPI) reduced sunitinib efficacy in a retrospective review of patients with metastatic renal cell carcinoma (N=231). Patients who took sunitinib concurrently with continuous gastric acid suppression (PPI) had a significant decrease in progression-free survival (PFS; 18.9 vs 23.6 weeks) and overall survival (OS; 40.9 vs 62.4 weeks) compared with patients who did not take a PPI during sunitinib therapy. Neither pharmacokinetics 1 nor drug levels were assess during sunitinib treatment in the patients included in this review.

Common questions

Can I take Esomeprazole and Sunitinib together?

Reduction in sunitinib bioavailability Always confirm with your pharmacist or prescriber before making any change.

How serious is the Esomeprazole and Sunitinib interaction?

It is rated major. Potentially serious — often needs a change or close 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 "probable". Good supporting evidence, though not definitively proven.

Questions for your pharmacist

  • Does my dose of Esomeprazole or Sunitinib 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 (1)

  1. Ha VH, Ngo M, Chu MP, et al: Does gastric acid suppression affect sunitinib efficacy in patients with advanced or metastatic renal cell cancer?. J Oncol Pharm Pract 2015; 21(3):194-200. PubMed
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Sunitinib

Keep reading about Sunitinib

All Sunitinib interactions (87) Sunitinib drug information
Also serious with: Ketoconazole Topical Colchicine Ofloxacin Oxaliplatin Injection
Esomeprazole

Keep reading about Esomeprazole

All Esomeprazole interactions (106) Esomeprazole drug information
Also serious with: Rilpivirine Dacomitinib Belumosudil Clopidogrel
Beyond drug–drug

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:

Sunitinib + Activated Charcoal Grapefruit St. John's Wort Acacia Rigidula Adrafinil African Wild Potato American Elder Astaxanthin + 130 more
Esomeprazole + Activated Charcoal Grapefruit St. John's Wort Acacia Rigidula Adrafinil African Wild Potato American Elder Artichoke + 146 more

major · moderate · minor — check everything you take with our drug–supplement interaction checker.

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This information is for education, not a substitute for professional medical advice. Do not start, stop, or change any medication without talking to your pharmacist or prescriber.