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Drug Interactions between Aciphex Sprinkle and Luvox CR

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

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Interactions between your drugs

Moderate

fluvoxaMINE RABEprazole

Applies to: Luvox CR (fluvoxamine) and Aciphex Sprinkle (rabeprazole)

MONITOR: Coadministration with fluvoxamine may increase the plasma concentrations of omeprazole and other proton pump inhibitors in a dose-dependent manner. The mechanism is fluvoxamine inhibition of the CYP450 2C19 metabolism of proton pump inhibitors. In 12 healthy volunteers, pretreatment with fluvoxamine for 7 days (10 mg once or twice a day) resulted in a 174% increase in the mean 8-hour area under the plasma concentration-time curve (AUC) of a single 20 mg oral dose of omeprazole compared to administration of omeprazole alone. When the dosage of fluvoxamine was increased (25 mg once or twice a day for 7 days), the mean 8-hour AUC of single-dose omeprazole increased 330%. The interaction apparently does not occur in poor metabolizers (PMs) of CYP450 2C19, which comprise approximately 3% to 5% of the Caucasian and 17% to 20% of the Asian population. In 18 healthy volunteers--six each of homozygous extensive metabolizers (EMs), heterozygous EMs, and PMs of CYP450 2C19--fluvoxamine (25 mg orally twice a day for 6 days) increased the Cmax, AUC, and elimination half-life (T1/2) of a single 40 mg oral dose of omeprazole by 3.7-, 6.2-, and 2.6-fold, respectively, in homozygous EMs and by 2.0-, 2.5, and 1.4-fold, respectively, in heterozygous EMs compared to placebo. The AUC ratio of 5-hydroxyomeprazole to omeprazole, which is considered an index of CYP450 2C19 activity, was decreased during fluvoxamine treatment to 17% in homozygous EMs and 49% in heterozygous EMs. In contrast, no changes in omeprazole pharmacokinetics or AUC ratio of 5-hydroxyomeprazole to omeprazole were observed in PMs. No adverse effects were attributed to the increased omeprazole exposure in the study.

MANAGEMENT: Although proton pump inhibitors are generally well tolerated, caution is advised if they are prescribed with fluvoxamine. Dosage adjustment should be considered in patients who experience excessive adverse effects such as drowsiness, blurred vision, tachycardia, nausea, vomiting, diaphoresis, flushing, headache, and dry mouth.

References

  1. "Product Information. PriLOSEC (omeprazole)." Merck & Co., Inc (2022):
  2. "Product Information. Prevacid (lansoprazole)." TAP Pharmaceuticals Inc PROD (2001):
  3. "Product Information. Aciphex (rabeprazole)." Janssen Pharmaceuticals PROD (2001):
  4. "Product Information. Protonix (pantoprazole)." Wyeth-Ayerst Laboratories PROD (2001):
  5. "Product Information. Nexium (esomeprazole)." Astra-Zeneca Pharmaceuticals PROD (2001):
  6. Christensen M, Tybring G, Mihara K, et al. "Low daily 10-mg and 20-mg doses of fluvoxamine inhibit the metabolism of both caffeine (cytochrome P4501A2) and omeprazole (cytochrome P4502C19)." Clin Pharmacol Ther 71 (2002): 141-52
  7. Yasui-Furukori N, Takahata T, Nakagami T, et al. "Different inhibitory effect of fluvoxamine on omeprazole metabolism between CYP2C19 genotypes." Br J Clin Pharmacol 57 (2004): 487-94
View all 7 references

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Drug and food interactions

Moderate

fluvoxaMINE food

Applies to: Luvox CR (fluvoxamine)

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

  1. Warrington SJ, Ankier SI, Turner P "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology 15 (1986): 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc. (1990):
  3. "Product Information. Fycompa (perampanel)." Eisai Inc (2012):
  4. "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc (2015):
View all 4 references

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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.

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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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