Drug interactions between clozapine and Nexium
| Results for the following 2 drugs: |
|---|
| clozapine |
| Nexium (esomeprazole) |
Interactions between your selected drugs
clozapine ↔ esomeprazole
Applies to:clozapine and Nexium (esomeprazole)
MONITOR: Coadministration with omeprazole may decrease the plasma concentrations of clozapine. The proposed mechanism is omeprazole induction of clozapine metabolism via CYP450 1A2. Two case reports describe patients stabilized on clozapine who experienced a 42% and 45% decrease in their plasma clozapine levels following the addition of omeprazole. No changes in their clinical presentation were noted, however. In a retrospective study of the medical files of 13 psychiatric patients receiving both clozapine and omeprazole, a switch to pantoprazole was associated with a significant rise of the serum clozapine levels in all nonsmokers relative to smokers, although the daily dosage of clozapine was unchanged. Presumably, the increase was due to the discontinuation of CYP450 1A2 induction by omeprazole in nonsmokers, whereas the isoenzyme remained induced in patients who smoked, as cigarette smoke is a known inducer of CYP450 1A2. Theoretically, this interaction could also occur with esomeprazole, the S-enantiomer of omeprazole.
MANAGEMENT: Pharmacologic response and serum clozapine levels should be monitored more closely whenever omeprazole or esomeprazole is added to or withdrawn from therapy, and the clozapine dosage adjusted as necessary. Alternatively, use of another proton pump inhibitor such as pantoprazole may be considered.
See also...
Drug Interaction Classification
The classifications below are a guideline only. The relevance of a particular drug interaction to a specific patient is difficult to determine using this tool alone given the large number of variables that may apply.
| Major | Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. |
| Moderate | Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. |
| Minor | Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. |
Do not stop taking any medications without consulting your healthcare provider.
Disclaimer: Every effort has been made to ensure that the information provided by Multum is accurate, up-to-date, and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. Multum's drug information does not endorse drugs, diagnose patients, or recommend therapy. Multum's drug information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug of drug combination is safe, effective, or appropriate for any given patient. Multum Information Services, Inc. does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. Copyright 2000-2012 Multum Information Services, Inc. The information in contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse, or pharmacist.
