Omeprazole and Omaveloxolone: 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
Omaveloxolone
Omeprazole
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.
Here's what's going on when you take Skyclarys (omaveloxolone) together with Prilosec (omeprazole). Omaveloxolone can gently speed up an enzyme in your body called CYP3A4. Omeprazole is partly broken down by that enzyme, so speeding it up may lower the amount of omeprazole in your system. In plain terms, your acid-reducing medicine might not work quite as well, so you could notice more heartburn or stomach discomfort.
The good news is this is based mostly on theory, not strong real-world reports, and it's very manageable. If your reflux symptoms creep back, let your pharmacist or doctor know. They can adjust things or check that your treatment is still doing its job.
Effect: Omaveloxolone is a weak CYP3A4 inducer and may increase metabolism of CYP3A4 substrates, reducing their exposure and efficacy. Omeprazole is metabolized partly by CYP3A4 (and primarily CYP2C19), so its plasma levels and acid-suppressing effect could be modestly reduced.
- Direction: Induction lowers omeprazole exposure (reduced effect).
- Magnitude: Not quantified for omeprazole; midazolam AUC fell ~45% in a PK study.
- Onset: Unspecified (induction is typically gradual).
- Evidence: Theoretical.
Management: Monitor for loss of acid-suppression efficacy (recurrent reflux/dyspepsia). Dose may be adjusted and individualized if symptoms indicate reduced control.
What happens
Reduced CYP3A4 substrate exposure and reduced efficacy of CYP3A4 substrate
Interaction Deep Dive
When omaveloxolone (a weak inducer of CYP3A4) is taken together with substrates of CYP3A4, the exposure to those substrates may fall, potentially diminishing their therapeutic effect. Watch for reduced efficacy of the co-administered agent whenever a CYP3A4 substrate is given alongside omaveloxolone. A drug interaction study demonstrated that co-administering omaveloxolone with midazolam (a CYP3A4 substrate) lowered the AUC of midazolam by roughly 45%1.
Why it happens (mechanism)
Induction of CYP3A4 substrate metabolism by omaveloxolone
How to manage this interaction
Keep taking both medicines exactly as prescribed. This is a theoretical concern, and your care team can manage it easily.
- Watch for lost effect: returning heartburn, acid reflux, or stomach discomfort may signal the omeprazole is working less well.
- Report symptoms: tell your pharmacist or prescriber if reflux comes back or worsens.
- Individualized care: your team may monitor you more closely, and your omeprazole dose can be adjusted and tailored to keep your symptoms controlled.
Do not start, stop, or change either medication on your own.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) In a study evaluating drug interactions, coadministration of omaveloxolone with midazolam reduced the AUC of midazolam (a CYP3A4 substrate) by roughly 45% 1.
Common questions
Can I take Omeprazole and Omaveloxolone together?
Omaveloxolone may slightly weaken omeprazole's effect by speeding up its breakdown, so watch for returning heartburn and tell your pharmacist or doctor if it comes back. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Omeprazole and Omaveloxolone 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 is the Omeprazole and Omaveloxolone interaction managed?
Keep taking both medicines exactly as prescribed. This is a theoretical concern, and your care team can manage it easily. Watch for lost effect: returning heartburn, acid reflux, or stomach discomfort may signal the omeprazole is working less well. Report symptoms: tell your pharmacist or prescriber if reflux comes back or worsens. Individualized care: your team may monitor you more closely, and y… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
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 Omaveloxolone 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: Skyclarys® oral capsules, omaveloxolone oral capsules. Biogen U.S. Corporation, Cambridge, MA, 2026. DailyMed
Keep reading about Omaveloxolone
Keep reading about Omeprazole
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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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