Nizatidine and Erlotinib: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Erlotinib
Nizatidine
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 erlotinib exposure
Interaction Deep Dive
The solubility of erlotinib is pH dependent and decreases as pH increases1. Concomitant use of erlotinib and a histamine-2 receptor antagonists (ranitidine or famotidine) has decreased erlotinib solubility and exposure in 2 pharmacokinetic studies 23. However, the effects on erlotinib exposure were minimized when ranitidine and erlotinib administration were staggered 3. If coadministration of erlotinib with a histamine-2 (H2) receptor antagonist is required, adjust the dosing schedule rather than increasing the erlotinib dosage, which would not compensate for loss of exposure. Administer erlotinib 10 hours after receiving a dose of the H2-receptor antagonist and at least 2 hours before the next H2-receptor antagonist dose 1.
Why it happens (mechanism)
PH-related reduction in erlotinib solubility and subsequent reduction in absorption
Literature reports
2 reports — tap to read
a) Coadministration of erlotinib and histamine-2 receptor antagonists (n=6) compared with patients receiving only erlotinib (n=24) resulted in a nonsignificant decrease in the plasma-to-dose ratio of erlotinib (0.48 vs 0.51 mcg/[mL x mg x kg]) and increase in erlotinib oral clearance (4.82 vs 3.95 L/hr) in a pharmacokinetic study of patients receiving erlotinib for treatment of non-small cell lung cancer. Histamine-2 receptor antagonists included famotidine (n=4) or ranitidine (n=2) 2.
b) In a pharmacokinetic study (N=24), administration of erlotinib 150 mg 2 hours after ranitidine 300 mg once daily resulted in significantly reduced erlotinib AUC by 33% and Cmax by 54% compared with erlotinib alone. When erlotinib was given 10 hours after ranitidine 150 mg twice daily and 2 hours prior to the next ranitidine dose, the erlotinib AUC and Cmax decreased by 15% and 17%, respectively. Exposure to the major active metabolite, OSI-420, was similarly effected in both ranitidine dosing regimens 3.
Common questions
Can I take Nizatidine and Erlotinib together?
Reduced erlotinib exposure Always confirm with your pharmacist or prescriber before making any change.
How serious is the Nizatidine and Erlotinib 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 "established". Well documented — supported by controlled studies or strong clinical data.
Questions for your pharmacist
- Does my dose of Nizatidine or Erlotinib 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)
- Product Information: TARCEVA(R) oral tablets, erlotinib oral tablets. Genentech USA Inc (per FDA), South San Francisco, CA, 2016. DailyMed
- Ohgami M, Kaburagi T, Kurosawa A, et al: Effects of proton pump inhibitor coadministration on the plasma concentration of erlotinib in patients with non-small cell lung cancer. Ther Drug Monit 2018; 40(6):699-704. PubMed
- Kletzl H, Giraudon M, Ducray PS, et al: Effect of gastric pH on erlotinib pharmacokinetics in healthy individuals: omeprazole and ranitidine. Anticancer Drugs 2015; 26(5):565-572. DOI
Keep reading about Erlotinib
Keep reading about Nizatidine
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:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
Check another combination
Our instant two-drug interaction checker is almost here.
Still have questions about this combination?
Every question gets a real answer from a licensed pharmacist — free, and usually within a day.
Ask the pharmacist