Lansoprazole and Ledipasvir: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Lansoprazole
Ledipasvir
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 ledipasvir exposure and loss of efficacy
Interaction Deep Dive
Use caution with coadministration of ledipasvir/sofosbuvir and proton pump inhibitors, as decreased ledipasvir exposure and loss of efficacy may occur. In 2 drug interaction studies (N=33), significant decreases in ledipasvir Cmax (48%) and AUC (42%) occurred when omeprazole 20 mg/day was administered 2 hours before ledipasvir, but not when simultaneously administered1. In 2 case reports, liver-transplant patients reinitiated on a proton pump inhibitor following induction of ledipasvir/sofosbuvir, resulted in improvement of duodenal ulcer without loss of sustained virologic response 2. If coadministration is required, give the proton pump inhibitor dose simultaneously with ledipasvir/sofosbuvir dose, under fasted conditions, and at a dose comparable to omeprazole 20 mg/day or lower 1.
Why it happens (mechanism)
Loss of ledipasvir solubility due to increased pH
Literature reports
2 reports — tap to read
a) In 2 case reports, liver-transplant patients who discontinued proton pump inhibitors (lansoprazole or rabeprazole) with the induction of ledipasvir/sofosbuvir for prophylaxis of hepatitis C virus reinfection, developed hemorrhagic duodenal ulcers. Subsequent reinitiation of a proton pump inhibitor, esomeprazole 20 mg/day in both patients resulted in improvement of the ulcer without loss of sustained virologic response (SVR). Hepatitis C virus RNA was negative at 8 and 4 weeks, and a SVR was achieved 12 weeks after the end of treatment in both patients 2.
b) In 2 drug interaction studies (N=33), simultaneous administration of a single ledipasvir 90-mg dose with omeprazole 20 mg/day did not significantly alter ledipasvir Cmax or AUC. However, when omeprazole 20 mg/day was administered 2 hours before single-dose ledipasvir 30 mg, significant decreases in ledipasvir Cmax (48%) and AUC (42%) occurred 1.
Common questions
Can I take Lansoprazole and Ledipasvir together?
Decreased ledipasvir exposure and loss of efficacy Always confirm with your pharmacist or prescriber before making any change.
How serious is the Lansoprazole and Ledipasvir 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.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Lansoprazole or Ledipasvir 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 (2)
- Product Information: HARVONI(R) oral tablets, ledipasvir sofosbuvir oral tablets. Gilead Sciences, Inc. (per manufacturer), Foster City, CA, 2014. DailyMed
- Miuma S, Miyaaki H, Miyazoe Y, et al: Development of duodenal ulcers due to the discontinuation of proton pump inhibitors after the induction of sofosbuvir plus ledipasvir therapy: a report of two cases. Transplant Proc 2018; 50(1):222-225. PubMed
Keep reading about Lansoprazole
Keep reading about Ledipasvir
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