Drug Interactions between lansoprazole and ledipasvir / sofosbuvir

ADJUST DOSE: Coadministration of ledipasvir with proton pump inhibitors may reduce its gastrointestinal absorption. Ledipasvir exhibits pH-dependent solubility, with increased solubility at lower pH. In 17 healthy volunteers, mean ledipasvir peak plasma concentration (Cmax) and systemic exposure (AUC) decreased by 48% and 42%, respectively, when a single 30 mg dose of ledipasvir was administered 2 hours after omeprazole given at a dosage of 20 mg once daily. When a single 90 mg-400 mg dose of ledipasvir-sofosbuvir was administered simultaneously with omeprazole 20 mg once daily, mean ledipasvir Cmax decreased by 11% and AUC decreased by just 4%.

MANAGEMENT: Proton-pump inhibitors at doses comparable to omeprazole 20 mg or lower should only be administered either simultaneously with or up to 2 hours after ledipasvir-sofosbuvir under fasted conditions. Some authorities advise against administering proton pump inhibitors before ledipasvir-containing products; however, a timeframe of dosage separation has not been specified.