nexium-i-v and Ketoconazole Interactions

Interactions between nexium-i-v(esomeprazole) and Ketoconazole (ketoconazole)

ketoconazole and esomeprazole (Moderate Drug-Drug)

MONITOR: Proton pump inhibitors may decrease the gastrointestinal absorption of the azole antifungal agents, itraconazole and ketoconazole, both of which require an acidic environment for dissolution. By increasing gastric pH and reducing the acidity, proton pump inhibitors can decrease bioavailability of the azoles by 75% to 80%.

MANAGEMENT: If coadministration is necessary, an acidic pH may be produced with two capsules of glutamic acid hydrochloride administered 15 minutes before the azole dose. Administration with an acidic beverage such as Coca-Cola(R) or Pepsi(R) may also help. However, clinicians should still consider the possibility of a reduced or subtherapeutic antifungal effect. It may be appropriate to switch to an agent like fluconazole or terbinafine whose absorption is not affected by stomach pH.