Drug interactions between Nexium and Noxafil
| Results for the following 2 drugs: |
|---|
| Nexium (esomeprazole) |
| Noxafil (posaconazole) |
Interactions between your selected drugs
esomeprazole ↔ posaconazole
Applies to:Nexium (esomeprazole) and Noxafil (posaconazole)
GENERALLY AVOID: Coadministration with an H2-receptor antagonist or a proton pump inhibitor may decrease the plasma concentrations of posaconazole. The proposed mechanism is reduced absorption of posaconazole due to an increase in gastric pH induced by these agents. According to the product labeling, posaconazole mean peak plasma concentration (Cmax) and systemic exposure (AUC) were reduced by 39% during coadministration of posaconazole (200 mg tablets once a day) with cimetidine (400 mg twice a day) for 10 days, while no clinically relevant effect on posaconazole bioavailability and/or plasma concentration was observed during coadministration with antacid, other H2-receptor antagonists, or proton pump inhibitors. However, in a pharmacokinetic study presented at the 18th European Congress of Clinical Microbiology and Infectious Diseases (April 2008), mean Cmax and AUC of posaconazole (400 mg single dose) were reduced by 46% and 32%, respectively, in 12 healthy subjects following pretreatment with esomeprazole (40 mg once a day for 3 days). In the same study, coadministration of posaconazole with 12 ounces of ginger ale, an acidic beverage, increased posaconazole Cmax by 92% and AUC by 70%. These data support the assumption that posaconazole bioavailability is dependent on gastric pH.
MANAGEMENT: The use of posaconazole in combination with H2-receptor antagonists or proton pump inhibitors should generally be avoided. If possible, prescribers may consider suspending the acid-suppressing agent until completion of posaconazole therapy, or substituting an antifungal agent like fluconazole or voriconazole whose absorption is not affected by stomach pH.
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.
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