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Drug Interactions between gefitinib and Nexium

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Major

esomeprazole gefitinib

Applies to: Nexium (esomeprazole) and gefitinib

GENERALLY AVOID: Coadministration with drugs that elevate gastric pH may decrease the plasma concentrations of gefitinib. According to the manufacturer, the solubility of gefitinib is pH-dependent and decreases sharply between pH 4 and 6, becoming practically insoluble above pH 7. When gefitinib 250 mg was administered to healthy male volunteers (n=26) one hour following two oral 450 mg doses of ranitidine with sodium bicarbonate as needed to achieve a sustained gastric pH above 5.0, mean gefitinib peak plasma concentration (Cmax) and systemic exposure (AUC) decreased by 71% and 47%, respectively, compared to administration of gefitinib alone. The interaction has not been studied with proton pump inhibitors.

MANAGEMENT: Concomitant use of gefitinib with proton pump inhibitors should generally be avoided. If coadministration is required, the manufacturer recommends administering gefitinib 12 hours after the last dose or 12 hours before the next dose of the proton pump inhibitor.

References

  1. (2023) "Product Information. Iressa (gefitinib)." Astra-Zeneca Pharmaceuticals
  2. (2022) "Product Information. Apo-Gefitinib (gefitinib)." Apotex Inc
  3. (2023) "Product Information. Iressa (gefitinib)." AstraZeneca UK Ltd
  4. (2021) "Product Information. Iressa (gefitinib)." AstraZeneca Pty Ltd
  5. Tang W, Tomkinson H, Masson E (2017) "Effect of sustained elevated gastric pH levels on gefitinib exposure." Clin Pharmacol Drug Dev, 6, p. 517-23
View all 5 references

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Drug and food interactions

Moderate

esomeprazole food

Applies to: Nexium (esomeprazole)

ADJUST DOSING INTERVAL: Food may interfere with the absorption of esomeprazole. The manufacturer reports that the area under the concentration-time curve for esomeprazole following a single 40 mg dose was 33% to 53% lower when administered after food intake as opposed to during fasting conditions.

MANAGEMENT: Esomeprazole should be taken at least one hour before meals. When administered to patients receiving continuous enteral nutrition, some experts recommend that the tube feeding should be interrupted for at least 1 hour before and 1 hour after the dose of esomeprazole is given.

References

  1. (2001) "Product Information. Nexium (esomeprazole)." Astra-Zeneca Pharmaceuticals
  2. Wohlt PD, Zheng L, Gunderson S, Balzar SA, Johnson BD, Fish JT (2009) "Recommendations for the use of medications with continuous enteral nutrition." Am J Health Syst Pharm, 66, p. 1438-67

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
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.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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