Nizatidine and Neratinib: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Neratinib
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
Decreased neratinib solubility, absorption, and exposure
Interaction Deep Dive
Coadministration of neratinib with agents that increase the gastric pH, such as an H2-receptor antagonist, may result in a decrease in neratinib plasma concentration and AUC resulting in reduced efficacy. A single oral dose of neratinib 240 mg given 2 hours following a dose of ranitidine 300 mg, resulted in a decrease in the neratinib Cmax by 57% and AUC by 48%. Give neratinib at least 2 hours before the next dose of the H2-receptor antagonist or 10 hours after the H2-receptor antagonist1.
Why it happens (mechanism)
Increased gastric pH by the H2-receptor antagonist
Literature reports
1 report — tap to read
a) A single oral dose of neratinib 240 mg given 2 hours following a dose of ranitidine 300 mg, resulted in a decrease in the neratinib Cmax by 57% and AUC by 48%. When a single oral dose of neratinib 240 mg was administered 2 hours prior to ranitidine 150 mg twice daily (administered in the morning and evening, approximately 12 hours apart), the neratinib Cmax and AUC were reduced by 44% and 32%, respectively 1.
Common questions
Can I take Nizatidine and Neratinib together?
Decreased neratinib solubility, absorption, and exposure Always confirm with your pharmacist or prescriber before making any change.
How serious is the Nizatidine and Neratinib 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 "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Nizatidine or Neratinib 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 (1)
- Product Information: NERLYNX(R) oral tablets, neratinib oral tablets. Puma Biotechnology Inc (per FDA), Los Angeles, CA, 2018. DailyMed
Keep reading about Neratinib
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.
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