Lansoprazole with Ledipasvir Interaction Details

Brand Names Associated with Lansoprazole

Brand Names Associated with Ledipasvir

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Nov 17, 2023

Interaction Effect

Decreased ledipasvir exposure and loss of efficacy

Interaction Summary

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 administered. 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 . 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 .

Severity

Major

Onset

Unspecified

Evidence

Theoretical

How To Manage Interaction

Use caution with coadministration of ledipasvir/sofosbuvir and proton pump inhibitors, as decreased ledipasvir plasma concentrations and loss of efficacy may occur. If concurrent use is required, give the proton pump inhibitor dose simultaneously with ledipasvir/sofosbuvir, under fasted conditions, and at a dose comparable to omeprazole 20 mg/day or lower.

Mechanism Of Interaction

Loss of ledipasvir solubility due to increased pH

Literature Reports

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 .

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 .

Lansoprazole Overview

• Prescription lansoprazole is used to treat the symptoms of gastroesophageal reflux disease (GERD), a condition in which backward flow of acid from the stomach causes heartburn and possible injury of the esophagus (the tube between the throat and stomach) in adults and children 1 year of age and older. Prescription lansoprazole is used to treat the damage from GERD in adults and children 1 year of age and older. Prescription lansoprazole is used to allow the esophagus to heal and prevent further damage to the esophagus in adults with GERD. Prescription lansoprazole is also used to treat ulcers (sores in the lining of the stomach or intestine), to prevent more ulcers from developing in adults whose ulcers have already healed, and to decrease the risk that adults who are taking nonsteroidal anti-inflammatory drugs (NSAIDs) will develop ulcers. Prescription lansoprazole is also used to treat conditions where the stomach produces too much acid, such as Zollinger-Ellison syndrome in adults. Prescription lansoprazole is also used in combination with other medications to treat and prevent stomach ulcers caused by a certain type of bacteria (H. pylori) in adults. Nonprescription (over-the-counter) lansoprazole is used to treat frequent heartburn (heartburn that occurs two or more days per week) in adults. Lansoprazole is in a class of medications called proton pump inhibitors. It works by decreasing the amount of acid made in the stomach.

Ledipasvir Overview

• The combination of ledipasvir and sofosbuvir is used alone or in combination with ribavirin (Copegus, Rebetol, Ribasphere, others) to treat certain types of chronic hepatitis C (an ongoing viral infection that damages the liver) in adults and children 3 years of age and older. Sofosbuvir is in a class of antiviral medications called nucleotide polymerase inhibitors. It works by decreasing the amount of hepatitis C virus (HCV) in the body. Ledipasvir is in a class of antiviral medications called HCV NS5A inhibitors. It works by stopping the virus that causes hepatitis C from spreading inside the body.

Return To Our Drug Interaction Homepage

Feedback, Question Or Comment About This Information?

Definitions

Severity Categories

Contraindicated

These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.

Major

This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.

Moderate

This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.

Minor

While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.

Onset

Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.

Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.

Evidence

Level of documentation of the interaction.

Established: The interaction is documented and substantiated in peer-reviewed medical literature.

Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.

How To Manage The Interaction

Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.

It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.

Mechanism Of Interaction

The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.

Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.

Where Does Our Information Come From?

Information for our drug interactions is compiled from several drug compendia, including:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

The prescribing information for each drug, as published on DailyMED, is also used. 

Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.

The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.