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Which Drugs Reaact With Proton Pump Inhibitors?

By: Suzanne Elvidge BSc (hons), MSc - Updated: 15 Sep 2012 |
 
Which Drugs Reaact With Proton Pump Inhibitors?

Proton pump inhibitors reduce the amount of acid in the stomach, by stopping the last stage of acid production.

Proton pump inhibitors are used to treat acid indigestion, caused by excess stomach acid; ulcers, where stomach acid damages the walls of the oesophagus, stomach (peptic ulcers) or duodenum (duodenal ulcers); heartburn (acid reflux), caused by stomach acid leaking back from the stomach into the oesophagus (gastroesophageal reflex disease or GERD); and inflammation of the oesophagus (oesophagitis), stomach (gastritis) and duodenum (duodenitis).

Talk to a pharmacist or doctor if you have any concerns over food or drug interactions, or if you are taking a new drug or food supplement, even if it is a common, over-the-counter one. Carefully read any instructions with the medicine.

What’s in a Proton Pump Inhibitor?

The active ingredients in proton pump inhibitors can include:

  • omeprazole
  • lansoprazole
  • esomeprazole
  • pantoprazole
  • rabeprazole.

What Drugs Interact With Proton Pump Inhibitors?

Lansoprazole and rabeprazole may have weaker interactions with other drugs than omeprazole.

By changing the acidity levels in the stomach, proton pump inhibitors can affect the absorption of drugs that depend on the level of acidity.

Proton pump inhibitors reduce the absorption (and so reduce the activity) of ampicillin (an antibiotic), azole antifungals (including posaconazole, itraconazole, orketoconazole and ketoconazole), delavirdine (used in HIV infection), protease inhibitors (used in HIV infection, including atazanavir, indinavir, lopinavir and nelfinavir), and tyrosine kinase inhibitors, used in cancer treatment (including sorafenib, dasatinib and gefitinib). This reduction in acidity can also reduce the amount of phosphate that sevelamer can bind. Sevelamer reduces the phosphate in the blood in people with kidney failure.

Proton pump inhibitors increase the solubility of raltegravir (used in HIV infection), so increasing its concentration in the blood and increasing its activity, with a potential increase in side effects.

Proton pump inhibitors and clarithromycin (an antibiotic) reduce each other’s breakdown (metabolism) in the body, so each drug makes the other more potent. This is used as a plus point in the treatment of stomach ulcers caused by a bacterial infection (Helicobacter pylori), but in other circumstances it could also increase side effects.

Proton pump inhibitors reduce the body’s removal of digoxin (used in heart disease) and diazepam (an anti-anxiety drug), so making the drugs more active, and potentially increasing their side effects.

Using proton pump inhibitors with warfarin can increase bleeding.

If omeprazole, saquinavir and ritonavir are given together, omeprazole can increase the blood concentration of saquinavir, potentially increasing its side effects.

Omeprazole reduces the blood concentration of cloazapine (used to treat schizophrenia) reducing its effects – it is thought that omeprazole increases the breakdown of clozapine.

Omeprazole and pantoprazole can increase the blood concentration of methotrexate (used in cancer treatment), so making it more active, and potentially increasing its side effects.

Lansoprazole may reduce the breakdown of tacrolimus (used to prevent the rejection of organs after transplant), making it more active and potentially increasing its side effects.

H2 blockers, also used to reduce stomach acid, reduce the effect of proton pump inhibitors because their mode of action. Sucralfate, used to treat duodenal ulcers, reduces the absorption of proton pump inhibitors and so makes them less active, and should be taken at least 30 minutes apart.

Voriconazole, an antifungal drug, can make proton pump inhibitors more active, and potentially increase their side effects.

What Foods Interact With Proton Pump Inhibitors?

By changing the acidity levels in the stomach, proton pump inhibitors can affect the absorption of nutrients that depend on the level of acidity. Proton pump inhibitors reduce the absorption (and so reduce the activity) of iron salts and cyanocobalamin (vitamin B12).

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