Lansoprazole with Voriconazole Interaction Details
Brand Names Associated with Lansoprazole
- Lansoprazole
- Prevacid®
- Prevacid® 24HR
- Prevacid® NapraPAC® (as a combination product containing Lansoprazole, Naproxen)
- Prevacid® SoluTab®
Brand Names Associated with Voriconazole
- Vfend®
- Voriconazole
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 17, 2023
Interaction Effect
Increased plasma concentrations of lansoprazole
Interaction Summary
Lansoprazole is metabolized by CYP2C19 and CYP3A4. Concomitant administration with voriconazole, a strong inhibitor of CYP2C19 and CYP3A4, may cause increased lansoprazole plasma levels. Reduced doses of lansoprazole may be needed when coadministered with voriconazole. Monitor for increased adverse effects associated with lansoprazole . Case reports describe the occurrences of cholestatic hepatitis and Torsades de Pointes with concomitant therapy .
Severity
Major
Onset
Delayed
Evidence
Probable
How To Manage Interaction
Use caution if lansoprazole, a CYP2C19 and CYP3A4 substrate, is coadministered with a strong CYP2C19 and CYP3A4 inhibitor, such as voriconazole, as this may lead to increased lansoprazole plasma levels. Reduced doses of lansoprazole may be needed. Monitor for increased adverse effects associated with lansoprazole . .
Mechanism Of Interaction
Inhibition of CYP2C19- and CYP3A4-mediated lansoprazole metabolism by voriconazole
Literature Reports
A) A 44-year-old man taking long-term voriconazole 200 mg twice daily for pulmonary aspergillosis developed cholestatic hepatitis after beginning treatment with lansoprazole. He was also taking prednisone, trimethoprim/sulfamethoxazole, and insulin. He presented with painless jaundice and fatigue after 10 days of lansoprazole therapy. Liver function tests were as follows: AST 264 milliunits/mL, ALT 362 milliunits/mL, alkaline phosphatase 406 milliunits/mL, total bilirubin 14 mg/dL (240 micromol/L), and direct bilirubin 10 mg/dL (170 micromol/L). These were all normal 1 month prior; hepatitis A, B, and C virus tests were negative. Liver function returned to normal after 4 weeks of stoppage of both voriconazole and lansoprazole, and voriconazole was reintroduced without recurrence of symptoms. The Naranjo score for this interaction was calculated at 7, indicating that cholestatic hepatitis was probably precipitated by lansoprazole .
B) A 70-year-old man regularly receiving lansoprazole 30 mg daily experienced recurrent Torsades de Pointes (TdP) 27 days after initiating treatment with voriconazole. The patient was a heterozygous extensive CYP2C19 metabolizer. He was being treated with cytarabine and aclarubicin for acute myeloblastic leukemia; EKG during this phase was normal. On day 14, oral voriconazole 200 mg daily was initiated for invasive aspergillosis. His condition was unremarkable until day 40, when premature ventricular contractions and bigeminy were noted, progressing to TdP with QTc interval of 0.69 seconds. Voriconazole was stopped on day 40, and the patient was rechallenged with voriconazole on day 42 when he became febrile again. The patient had another run of self-limiting TdP on day 44. Despite discontinuation of voriconazole, on day 45 the patient experienced pulseless polymorphic ventricular tachycardia requiring 7 minutes of cardiopulmonary resuscitation. No further attempts were made to treat with voriconazole; his QTc interval normalized within 1 week .
C) Voriconazole has been demonstrated to increase systemic exposure to omeprazole (also a proton pump inhibitor (PPI)), via inhibition of CYP2C19 and CYP3A4. Although not specifically evaluated, voriconazole may inhibit the metabolism of other PPIs that are CYP2C19 or CYP3A4 substrates (eg, lansoprazole) and may increase plasma concentrations and adverse events associated with PPIs .
Lansoprazole Overview
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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.
Voriconazole Overview
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Voriconazole is used in adults and children 2 years of age and older to treat serious fungal infections such as invasive aspergillosis (a fungal infection that begins in the lungs and spreads through the bloodstream to other organs), esophageal candidiasis (a yeast [a type of fungus] infection that may cause white patching in the mouth and throat), and candidemia (a fungal infection in the blood). It is also used to treat certain other fungal infections when other medications will not work for certain patients. Voriconazole is in a class of antifungal medications called triazoles. It works by slowing the growth of the fungi that cause infection.
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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:
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.