Lansoprazole and Mycophenolate Mofetil: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Lansoprazole
Mycophenolate Mofetil
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
Reduced mycophenolic acid exposure
Interaction Deep Dive
Coadministration of proton pump inhibitors in single doses to healthy volunteers and multiple doses to transplant patients receiving mycophenolate mofetil has been reported to reduce the exposure to the active metabolite, mycophenolic acid (MPA). An approximate reduction of 30% to 70% in the Cmax and 25% to 35% in the AUC of MPA has been observed, possibly due to a decrease in MPA solubility at an increased gastric pH. Obtaining MPA plasma levels before and after the initiation or discontinuation of concomitant medications may be necessary to ensure MPA levels remain stable2. If coadministration of mycophenolate mofetil and a PPI is necessary, the dose of mycophenolate mofetil may need to be increased to reach equal immunosuppressive effects 4. Monitor patients for alterations in efficacy when coadministration with a PPI is required 2. Use omeprazole with caution in transplant patients receiving mycophenolate mofetil 1.
Why it happens (mechanism)
Incomplete dissolution and decreased absorption of mycophenolate mofetil when the gastric pH is increased
Literature reports
5 reports — tap to read
a) Administration of omeprazole 20 mg twice daily for 4 days and a single 1000 mg dose of mycophenolate mofetil approximately one hour after the last dose of omeprazole to 12 healthy subjects in a crossover study resulted in a 52% reduction in the Cmax and 23% reduction in the AUC of MPA 1.
b) Reduced exposure of mycophenolate mofetil (CellCept(R)), but not enteric-coated mycophenolate sodium (Myfortic(R)), was reported in healthy subjects when coadministered with omeprazole in 2 randomized, crossover design with a 1-week washout period pharmacokinetic studies (N=12 each). Mycophenolic acid (MPA) levels were compared following a single oral dose of mycophenolate mofetil 1000 mg or enteric-coated mycophenolate sodium 720 mg as monotherapy, or in combination with omeprazole 20 mg twice daily (started 4 days prior). All medications were administered in fasted state with 240 mL of water. Mean Cmax of MPA was 21.7 +/- 9.9 mg/L when mycophenolate mofetil was administered alone, compared with 10.5 +/- 3.6 mg/mL when administered in the presence of omeprazole (p less than 0.01). Mean AUC (0 to 12 hours) of MPA was 33.3 +/- 11.5 mg x hr/L when mycophenolate mofetil was administered alone, compared with 25.8 +/- 6.4 mg x hr/L when administered in the presence of omeprazole (p less than 0.05). In contrast, mean Cmax and AUC of MPA following administration of enteric-coated mycophenolate sodium were unaffected when administered alone (21.6 +/-6.5 and 31.8 +/- 7.7 mg/L, respectively) or in the presence of omeprazole (23.7 +/- 8 and 33.2 +/-6.5 mg/L, respectively) 3.
c) In a prospective, case-controlled pharmacokinetic study, coadministration of pantoprazole 40 mg with mycophenolate mofetil (1000 mg twice daily) and tacrolimus (dose adjusted to reach target trough levels 5 to 14 nanograms/mL) resulted in reduced mycophenolic acid concentrations in 22 heart transplant recipients. Coadministration with pantoprazole resulted in significant decreases in mycophenolic acid concentrations at 30 minutes (8.3 mg/L vs 18.3 mg/L (0.0259 mmol/L vs 0.0571 mmol/L)) and 1 hour (10 mg/L vs 15.8 mg/L (0.03 mmol/L vs 0.0493 mmol/L)), but not at 2 hours. Pantoprazole also significantly reduced mycophenolic acid AUC (51.2 mg x hr/L vs 68.7 mg x hr/L) and Cmax (12.2 mg/L vs 20.6 mg/L (0.038 mmol/L vs 0.0643 mmol/L)) and increased the time to reach Cmax (Tmax; 60 +/- 27.8 minutes vs 46.4 +/- 22.2 minutes) 4.
d) Coadministration of pantoprazole with mycophenolate mofetil significantly decreased mean serum concentrations of the active metabolite, mycophenolate acid (MPA), at 30 and 60 minutes postdose compared with subjects not receiving pantoprazole. Concomitant administration also significantly decreased Cmax and AUC and increased Tmax of MPA compared with subjects not receiving pantoprazole. Eligible subjects were receiving mycophenolate mofetil 1 to 2 g/day for autoimmune diseases (23 receiving concomitant pantoprazole 40 mg/day and 13 not receiving proton pump inhibitors (non-PPI)). Mean MPA plasma levels at 30 and 60 minutes postdose were significantly decreased in the pantoprazole-treated subjects compared with the non-PPI treated subjects ( 9.2 mg/L vs 30.3 mg/L (0.0287 mmol/L vs 0.0945 mmol/L) at 30 minutes and 11 mg/L vs 18.3 mg/L (0.034 mmol/L vs 0.0571 mmol/L) at 60 minutes). Cmax was significantly lowered in the pantoprazole-treated subjects compared with non-PPI subjects, (14.2 mg/L vs 35.4 mg/L (0.0443 mmol/L vs 0.1105 mmol/L)) and Tmax was significantly delayed (61.6 minutes vs 36.4 minutes, respectively). From 90 minutes to 12 hours postdose, MPA plasma concentrations did not differ significantly between groups. In the pantoprazole group, 5 patients experienced increased disease activity compared with 1 patient in the non-PPI group 5.
e) In a randomized crossover study of stable renal transplant patients (N=20), there was no significant difference in mycophenolic acid exposure when mycophenolate mofetil or enteric-coated mycophenolate sodium were administered with or without pantoprazole 6.
Common questions
Can I take Lansoprazole and Mycophenolate Mofetil together?
Reduced mycophenolic acid exposure Always confirm with your pharmacist or prescriber before making any change.
How serious is the Lansoprazole and Mycophenolate Mofetil interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "rapid". Effects can appear quickly, often within about 24 hours of combining the drugs.
How strong is the evidence for this interaction?
The evidence is graded "established". Well documented — supported by controlled studies or strong clinical data.
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 Mycophenolate Mofetil 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 (6)
- Product Information: KONVOMEP(TM) powder for oral suspension, omeprazole sodium bicarbonate powder for oral suspension. Azurity Pharmaceuticals Inc (per manufacturer), Woburn, MA, 2022. DailyMed
- Product Information: CELLCEPT(R) oral capsules, oral tablets, oral suspension, intravenous injection, mycophenolate mofetil oral capsules, oral tablets, oral suspension, intravenous injection. Genentech USA Inc (per FDA), South San Francisco, CA, 2022. DailyMed
- Kees MG, Steinke T, Moritz S, et al: Omeprazole impairs the absorption of mycophenolate mofetil but not of enteric-coated mycophenolate sodium in healthy volunteers. J Clin Pharmacol 2012; 52(8):1265-1272. PubMed
- Kofler S, Shvets N, Bigdeli AK, et al: Proton pump inhibitors reduce mycophenolate exposure in heart transplant recipients - a prospective case-controlled study. Am J Transplant 2009; 9(7):1650-1656. DOI
- Schaier M, Scholl C, Scharpf D, et al: Proton pump inhibitors interfere with the immunosuppressive potency of mycophenolate mofetil. Rheumatology (Oxford) 2010; 49(11):2061-2067. PubMed
- Rissling O, Glander P, Hambach P, et al: No relevant pharmacokinetic interaction between pantoprazole and mycophenolate in renal transplant patients: a randomized crossover study. Br J Clin Pharmacol 2015; 80(5):1086-1096. DOI
Keep reading about Lansoprazole
Keep reading about Mycophenolate Mofetil
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