Esomeprazole and Velpatasvir: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Esomeprazole
Velpatasvir
No brand names on record
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
Decreased velpatasvir exposure
Interaction Deep Dive
Coadministration of velpatasvir and this drug is not recommended as this may result in decreased velpatasvir exposure and a potential loss of efficacy. If concurrent use of a proton pump inhibitor is necessary, omeprazole at a dose not to exceed 20 mg may be given12. Administer the combination of sofosbuvir/velpatasvir with food at least 4 hours prior to omeprazole 2.
Why it happens (mechanism)
Decreased velpatasvir solubility due to pH increases
Literature reports
2 reports — tap to read
a) During pharmacokinetic studies, coadministration of omeprazole 20 mg once daily 2 hours prior to sofosbuvir 400 mg/velpatasvir 100 mg/voxilaprevir 100 mg resulted in a 57% decrease in velpatasvir Cmax and a 54% decrease in AUC. Administration 4 hours after sofosbuvir 400 mg/velpatasvir 100 mg/voxilaprevir 100 mg resulted in a 51% decrease in both velpatasvir Cmax and AUC 1.
b) During drug interaction studies, coadministration of omeprazole 20 mg simultaneously with velpatasvir 100 mg resulted in a 37% decrease in velpatasvir Cmax and a 36% decrease in AUC. Administration 12 hours prior to velpatasvir resulted in a decrease of 57% and 55%. Administration 2 hours prior to velpatasvir resulted in a 48% decrease and a 38% decrease. Administration 4 hours after velpatasvir resulted in a 33% and 26% decrease 3.
Common questions
Can I take Esomeprazole and Velpatasvir together?
Decreased velpatasvir exposure Always confirm with your pharmacist or prescriber before making any change.
How serious is the Esomeprazole and Velpatasvir 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 "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Esomeprazole or Velpatasvir 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: VOSEVI(TM) oral tablets, sofosbuvir velpatasvir voxilaprevir oral tablets. Gilead Sciences Inc (per manufacturer), Foster City, CA, 2017. DailyMed
- Product Information: EPCLUSA(R) oral tablets, sofosbuvir velpatasvir oral tablets. Gilead Sciences, Inc (per manufacturer), Foster City, CA, 2017. DailyMed
- Product Information: EPCLUSA(R) oral tablets, sofosbuvir velpatasvir oral tablets. Gilead Sciences Inc (per FDA), Foster City, CA, 2016. DailyMed
Keep reading about Esomeprazole
Keep reading about Velpatasvir
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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