Drug Interaction Report

Midostaurin and Vonoprazan: Interaction Details

A pharmacist-reviewed analysis of the Midostaurin and Vonoprazan 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

Vonoprazan

Voquezna
+

Midostaurin

Rydapt Rydapt®
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 133 documented Midostaurin interactions, 116 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 CYP3A substrates exposure

Interaction Deep Dive

Vonoprazan is a weak CYP3A inhibitor and may increase the exposure of CYP3A substrates where minimal concentration changes may lead to serious toxicities. A single oral dose of midazolam 2 mg (a CYP3A4 substrate) administered following vonoprazan, increased midazolam AUC 93% compared to administration of midazolam alone. When vonoprazan is used in combination with clarithromycin, a strong CYP3A inhibitor, the risk of increased exposure and side effects further increases. Frequently monitor concentrations and/or adverse reactions related to CYP3A substrates. Dosage reduction may be needed123.

Why it happens (mechanism)

Inhibition of CYP3A-mediated metabolism by vonoprazan

Literature reports

1 report — tap to read

a) When a single oral dose of midazolam 2 mg (a CYP3A4 substrate) was administered following vonoprazan 20 mg twice daily for 7 days (N=20), midazolam AUC increased 93% compared to administration of midazolam alone 123.

Common questions

Can I take Midostaurin and Vonoprazan together?

Increased CYP3A substrates exposure Always confirm with your pharmacist or prescriber before making any change.

How serious is the Midostaurin and Vonoprazan 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 Midostaurin or Vonoprazan 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: VOQUEZNA(R) oral tablets, vonoprazan oral tablets. Phathom Pharmaceuticals Inc (per FDA), Buffalo Grove, IL, 2023. DailyMed
  2. Product Information: VOQUEZNA(TM) DUAL PAK(TM) oral kit, vonoprazan oral tablets, amoxicillin oral capsules kit. Phathom Pharmaceuticals (per FDA), Buffalo Grove, IL, 2023. DailyMed
  3. Product Information: VOQUEZNA(TM) TRIPLE PAK(TM) oral kit, vonoprazan oral tablets, amoxicillin oral capsules, clarithromycin oral tablets kit. Phathom Pharmaceuticals (per FDA), Buffalo Grove, IL, 2023. DailyMed
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Vonoprazan

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All Vonoprazan interactions (47)
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Midostaurin

Keep reading about Midostaurin

All Midostaurin interactions (133) Midostaurin drug information
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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:

Midostaurin + Activated Charcoal Grapefruit St. John's Wort Acacia Rigidula Adrafinil African Wild Potato American Elder Astaxanthin + 130 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.