Drug Interaction Report

Esomeprazole and Voriconazole: Interaction Details

A pharmacist-reviewed analysis of the Esomeprazole and Voriconazole 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

Voriconazole

Vfend
+

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
theoretical
Severity
Major

What happens

Increased esomeprazole exposure, an increased voriconazole exposure and an increased risk of voriconazole-related adverse effects

Interaction Deep Dive

Avoid concomitant use of esomeprazole and voriconazole. Due to inhibition of CYP2C19-mediated esomeprazole metabolism by voriconazole, esomeprazole exposure may increase when administered concurrently with voriconazole. Although dose adjustment is not required1, in patients being treated with high doses (up to 240 mg/day orally) of esomeprazole for Zollinger-Ellison's syndrome, dose adjustments may be considered 2. Concomitant use of voriconazole with esomeprazole, a CYP2C19/CYP3A4 inhibitor may also increase voriconazole exposure. Adjust voriconazole dosage and monitor for adverse reactions 3.

Why it happens (mechanism)

Inhibition of CYP2C19-mediated metabolism of esomeprazole; inhibition of CYP2C19-mediated metabolism of voriconazole; inhibition of CYP3A4-mediated metabolism of voriconazole

Common questions

Can I take Esomeprazole and Voriconazole together?

Increased esomeprazole exposure, an increased voriconazole exposure and an increased risk of voriconazole-related adverse effects Always confirm with your pharmacist or prescriber before making any change.

How serious is the Esomeprazole and Voriconazole 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 Voriconazole 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)

  1. Product Information: VIMOVO(R) oral delayed release tablets, naproxen esomeprazole magnesium oral delayed release tablets. Horizon Pharma USA Inc (per FDA), Lake Forest, IL, 2016. DailyMed
  2. Product Information: NEXIUM(R) delayed-release oral tablets, esomeprazole magnesium delayed-release oral tablets. AstraZeneca,LP, Wilmington, DE, 2007. DailyMed
  3. Product Information: VFEND(R) oral tablets, oral suspension, intravenous injection, voriconazole oral tablets, oral suspension, intravenous injection. Roerig (per FDA), New York, NY, 2025. DailyMed
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Voriconazole

Keep reading about Voriconazole

All Voriconazole interactions (229)
Also serious with: Ivabradine Simvastatin Dihydroergotamine Nasal Spray Naloxegol
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:

Voriconazole + Activated Charcoal Beer Grapefruit Siberian Cocklebur St. John's Wort Wine Acacia Rigidula Adrafinil + 197 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.