Pantoprazole with Itraconazole Interaction Details
Brand Names Associated with Pantoprazole
- Pantoprazole
- Protonix®
Brand Names Associated with Itraconazole
- Itraconazole
- Onmel®
- Sporanox®
- Tolsura®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 09, 2023
Interaction Effect
Reduced itraconazole exposure
Interaction Summary
Concomitant use of itraconazole and agents that suppress or neutralize gastric pH (i.e., proton pump inhibitors H2 blocker, and antacids) may result in decreased gastrointestinal absorption of itraconazole and decreased itraconazole plasma concentrations and bioavailability. Use caution when itraconazole is administered with acid neutralizing medicines or acid secretion suppressors. Antacids should be administered at least 2 hours before or 2 hours after itraconazole. In a study when itraconazole was coadministered with ranitidine and antacids, serum concentrations of itraconazole were considerably lower compared with administration of itraconazole alone .
Severity
Moderate
Onset
Unspecified
Evidence
Theoretical
How To Manage Interaction
Concomitant use of itraconazole and agents that suppress or neutralize gastric pH (i.e., proton pump inhibitors, H2 blockers, and antacids) may result in decreased itraconazole absorption. Use caution when itraconazole is administered with acid neutralizing medicines or acid secretion suppressors. Antacids should be administered at least 2 hours before or 2 hours after itraconazole.
Mechanism Of Interaction
Decreased gastrointestinal absorption of itraconazole due to suppression or neutralization of gastric pH
Literature Reports
A) The absorption of itraconazole capsules was reduced when itraconazole 200 mg was given with water after ranitidine pretreatment of 150 mg twice daily for 3 days with decreases in AUC(0 to 24) and Cmax of 39% +/- 37% and 42% +/- 39%, respectively, in a study of 30 healthy men. When itraconazole was administered with cola after ranitidine pretreatment, itraconazole absorption was similar to that observed when itraconazole was administered alone .
B) The absorption of itraconazole capsules increased when administered with a cola beverage compared with water in subjects with relative or absolute achlorhydria such as patients with AIDS or volunteers receiving concomitant gastric acid secretion suppressors (eg, H2 blocker). Following a single 200-mg dose of itraconazole with 8 ounces of cola to 18 men with AIDS in a fasted state, the AUC(0 to 24) increased by 75% +/- 121% and Cmax increased by 95% +/- 128% .
C) The systemic availability of itraconazole was evaluated in 17 lung transplant recipients who were also taking ranitidine 150 mg every 12 hours and antacids. In patients receiving itraconazole 200 mg and 400 mg daily, the median serum concentrations were 0.5 mcg/mL and 3.5 mcg/mL, respectively. These serum levels were considerably lower than the levels recorded from previous studies, which have reported a median itraconazole serum concentration of 1.1 mcg/mL and 5.9 mcg/mL when itraconazole was administered in daily doses of 200 mg and 400 mg, respectively .
Pantoprazole Overview
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Pantoprazole is used to treat damage from gastroesophageal reflux disease (GERD), a condition in which backward flow of acid from the stomach causes heartburn and possible injury of the esophagus (the tube between the throat and stomach) in adults and children 5 years of age and older. Pantoprazole is used to allow the esophagus to heal and prevent further damage to the esophagus in adults with GERD. It is also used to treat conditions where the stomach produces too much acid, such as Zollinger-Ellison syndrome in adults. Pantoprazole is in a class of medications called proton-pump inhibitors. It works by decreasing the amount of acid made in the stomach.
Itraconazole Overview
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Itraconazole capsules (Sporanox, Tolsura) are used to treat fungal infections in the lungs that can spread throughout the body. Itraconazole capsules (Sporanox) are also used to treat fungal infections of the fingernails and toenails. Itraconazole oral solution (liquid) is used to treat yeast infections of the mouth and throat or of the esophagus (tube that connects the throat to the stomach). Itraconazole is in a class of antifungals called triazoles. It works by slowing the growth of fungi that cause infection.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.