Vonoprazan and Clindamycin: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 1, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Vonoprazan
Clindamycin
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. Vonoprazan (Voquezna) is a mild blocker of a liver enzyme called CYP3A. That enzyme helps break down clindamycin. When the enzyme is slowed down, a little more clindamycin can build up in your body, which could raise the chance of side effects like stomach upset or diarrhea.
The good news: this is based on theory, not strong real-world reports, and vonoprazan is only a weak blocker. Keep taking both exactly as prescribed, and let your pharmacist or doctor know if you notice new or worsening tummy problems. Your care team can easily watch for this and adjust your dose if needed.
Mechanism: Vonoprazan is a weak CYP3A inhibitor; clindamycin is partly metabolized by CYP3A4. Inhibition may modestly reduce clindamycin clearance and increase exposure (AUC).
Direction: increased clindamycin exposure (neither drug is a prodrug requiring activation here).
- Magnitude: unquantified for clindamycin; vonoprazan raised midazolam AUC ~93% as a reference substrate.
- Onset: unspecified.
- Evidence: theoretical.
- Management: monitor for CYP3A-substrate adverse effects (GI toxicity, C. difficile risk); dose reduction may be considered if warranted. Greater caution if a strong CYP3A inhibitor is co-administered.
What happens
Increased CYP3A substrates exposure
Interaction Deep Dive
As a weak inhibitor of CYP3A, vonoprazan has the potential to raise the exposure of CYP3A substrates, and in cases where even small shifts in concentration can trigger serious toxicities this is clinically relevant. Following vonoprazan, a single 2 mg oral dose of midazolam (a CYP3A4 substrate) produced a 93% rise in midazolam AUC relative to giving midazolam by itself. Combining vonoprazan with clarithromycin, which is a strong CYP3A inhibitor, elevates the risk of heightened exposure and adverse effects even more. Concentrations and/or adverse reactions tied to CYP3A substrates should be monitored frequently, and a reduction in dosage may be required123.
Why it happens (mechanism)
Inhibition of CYP3A-mediated metabolism by vonoprazan
How to manage this interaction
What your care team may do:
- Keep monitoring you a bit more closely for clindamycin side effects, mainly gut symptoms like diarrhea or stomach pain.
- Adjust and individualize your clindamycin dose if they feel it is needed.
- Be extra watchful if another CYP3A-blocking drug (such as clarithromycin) is added.
What you should do:
- Keep taking both medicines exactly as prescribed unless your prescriber tells you otherwise.
- Tell your pharmacist or doctor about any new or worsening diarrhea, cramping, or nausea.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
Common questions
Can I take Vonoprazan and Clindamycin together?
Vonoprazan may mildly increase clindamycin levels by slowing its CYP3A breakdown, so keep taking both as prescribed and report any new or worsening stomach or bowel symptoms to your care team. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Vonoprazan and Clindamycin 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 Vonoprazan and Clindamycin interaction managed?
What your care team may do: Keep monitoring you a bit more closely for clindamycin side effects, mainly gut symptoms like diarrhea or stomach pain. Adjust and individualize your clindamycin dose if they feel it is needed. Be extra watchful if another CYP3A-blocking drug (such as clarithromycin) is added. What you should do: Keep taking both medicines exactly as prescribed unless your prescriber te… 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 Vonoprazan or Clindamycin 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: VOQUEZNA(R) oral tablets, vonoprazan oral tablets. Phathom Pharmaceuticals Inc (per FDA), Buffalo Grove, IL, 2023. DailyMed
- Product Information: VOQUEZNA(TM) DUAL PAK(TM) oral kit, vonoprazan oral tablets, amoxicillin oral capsules kit. Phathom Pharmaceuticals (per FDA), Buffalo Grove, IL, 2023. DailyMed
- Product Information: VOQUEZNA(TM) TRIPLE PAK(TM) oral kit, vonoprazan oral tablets, amoxicillin oral capsules, clarithromycin oral tablets kit. Phathom Pharmaceuticals (per FDA), Buffalo Grove, IL, 2023. DailyMed
Keep reading about Vonoprazan
Keep reading about Clindamycin
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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