Omeprazole and Nilotinib: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 2, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Nilotinib
No brand names on recordOmeprazole
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.
Nilotinib is a cancer medicine that needs an acidic stomach to dissolve and get absorbed well. Omeprazole (Prilosec) works by lowering stomach acid. When you take them together, your stomach becomes less acidic, so less nilotinib gets into your body. That can make the nilotinib work less well, which matters a lot for a cancer treatment.
The good news is your care team can manage this easily. Please don't stop or change anything on your own. Talk with your pharmacist or oncologist, they may switch you to a different type of acid reducer or adjust the timing so your nilotinib still works the way it should.
Effect: Reduced nilotinib bioavailability and potential loss of efficacy.
Mechanism: Nilotinib solubility and absorption are pH-dependent; PPI-induced gastric acid suppression raises upper GI pH and decreases nilotinib dissolution/absorption. Onset rapid; evidence probable.
- Magnitude: Multiple-dose esomeprazole 40 mg reduced nilotinib AUC ~34%. A retrospective review (n=748, Ph+ CML chronic phase) found no significant efficacy change with PPI/H2RA use.
- Management: Avoid concomitant PPI. Prefer an H2RA dosed ~10 h before or 2 h after nilotinib, or an antacid ~2 h before or after nilotinib.
- Monitor: hematologic/molecular response (BCR-ABL).
What happens
Reduced nilotinib exposure and reduced efficacy of nilotinib
Interaction Deep Dive
Concurrent administration of a proton pump inhibitor (PPI) with nilotinib should be avoided, because it can lower nilotinib exposure and thereby diminish the drug's efficacy. As alternatives to PPIs, consider a histamine-2 receptor antagonist (H2RA) administered roughly 10 hours before or 2 hours after the nilotinib dose, or antacids taken about 2 hours before or 2 hours after the nilotinib dose. One study found that giving nilotinib together with multiple daily 40 mg doses of esomeprazole produced a 34% decrease in nilotinib AUC12. Nevertheless, a retrospective review of 2 clinical trials (n=748) involving patients with Philadelphia chromosome-positive chronic myeloid leukemia in chronic phase showed no meaningful difference in nilotinib efficacy when a PPI or H2 blocker was taken concurrently for any length of time, as compared with patients who did not use a PPI or H2 blocker 3.
Why it happens (mechanism)
Reduction in nilotinib bioavailability due to decreased solubility and absorption of nilotinib due to increased pH of the upper gastrointestinal tract caused by proton pump inhibitors
How to manage this interaction
Keep taking both medicines as prescribed until you speak with your care team, but do bring this up soon.
- Your team will usually avoid pairing a PPI like omeprazole with nilotinib because the acid reducer can lower how much nilotinib you absorb.
- They may switch you to a different type of acid reducer, such as an H2 blocker given about 10 hours before or 2 hours after your nilotinib dose.
- Or they may suggest an antacid taken about 2 hours before or 2 hours after your nilotinib.
Ask your pharmacist or oncologist which option fits you, and mention any heartburn medicines you take.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
3 reports — tap to read
a) A drug interaction study found that giving repeated doses of esomeprazole 40 mg once daily reduced the AUC of nilotinib by 34% 12.
b) A retrospective analysis of patients with newly diagnosed Philadelphia chromosome-positive chronic myelogenous leukemia in the chronic phase who were enrolled in a phase 3 study (n=492) showed that major molecular response (MMR) rates at 12 months were not altered by the concurrent use of proton pump inhibitors (PPI) or H2 blockers together with nilotinib. The PPIs comprised esomeprazole, lansoprazole, omeprazole, pantoprazole, and RABEprazole, while the H2 blockers comprised cimetidine, famotidine, and raNITIdine. MMR at 12 months was reached in 49.6% (59 of 119) of patients who took nilotinib along with a PPI or H2 blocker for any length of time, versus 41% (153 of 373) of patients who did not take any PPI or H2 blocker (p=0.13). The median length of concurrent use during nilotinib therapy was 137 days for PPIs and 33 days for H2 blockers, and 9.3% (46 of 492) of patients received concurrent therapy for more than 50% of the study period 3.
c) A retrospective analysis of imatinib-experienced patients with Philadelphia chromosome-positive chronic myelogenous leukemia in the chronic phase who were enrolled in a phase 2 study (n=256) showed that major cytogenic response (MCyR) and complete cytogenic response (CCyR) rates at 12 months were not altered by the concurrent use of proton pump inhibitors (PPI) or H2 blockers together with nilotinib. The PPIs comprised esomeprazole, lansoprazole, omeprazole, pantoprazole, and RABEprazole, while the H2 blockers comprised cimetidine, famotidine, and raNITIdine. MCyR at 12 months was reached in 64% (55 of 86) of patients who took nilotinib along with a PPI or H2 blocker for any length of time, versus 57.6% (98 of 170) of patients who did not take any PPI or H2 blocker (p=0.4), and CCyR at 12 months was reached in 45.3% (39 of 86) and 38.2% (65 of 170) of patients (p=0.34), respectively. The median length of concurrent use during nilotinib therapy was 177 days for PPIs and 96 days for H2 blockers, and 23% (59 of 256) of patients received concurrent therapy for more than 50% of the study period 3.
Common questions
Can I take Omeprazole and Nilotinib together?
Omeprazole lowers stomach acid, which can reduce how much of your cancer drug nilotinib you absorb and may make it less effective. Don't stop either drug on your own; ask your oncologist or pharmacist about a safer acid-reducer option or timing plan. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Omeprazole and Nilotinib 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 is the Omeprazole and Nilotinib interaction managed?
Keep taking both medicines as prescribed until you speak with your care team, but do bring this up soon. Your team will usually avoid pairing a PPI like omeprazole with nilotinib because the acid reducer can lower how much nilotinib you absorb. They may switch you to a different type of acid reducer, such as an H2 blocker given about 10 hours before or 2 hours after your nilotinib dose. Or they ma… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Omeprazole or Nilotinib 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: TASIGNA(R) oral capsules, nilotinib oral capsules. Novartis Pharmaceuticals Corporation (per FDA), East Hanover, NJ, 2024. DailyMed
- Product Information: DANZITEN oral tablets, nilotinib oral tablets. Azurity Pharmaceuticals, Inc. (per FDA), Woburn, MA, 2024. DailyMed
- Yin OQ, Giles FJ, Baccarani M, et al: Concurrent use of proton pump inhibitors or H2 blockers did not adversely affect nilotinib efficacy in patients with chronic myeloid leukemia. Cancer Chemother Pharmacol 2012; 70(2):345-350. PubMed
Keep reading about Nilotinib
Keep reading about Omeprazole
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