Drug Interaction Report

MONITOR: Coadministration with fenofibrate may increase the plasma concentrations and risk of adverse effects of drugs that are substrates of CYP450 2C19, 2A6, and 2C9 isoenzymes. The proposed mechanism, based on in vitro data, is decreased clearance due to fenofibrate-mediated inhibition of CYP450 2C19, 2A6, and 2C9.

MANAGEMENT: Until more information is available, caution is advised if fenofibrate is used concomitantly with drugs that are substrates of CYP450 2C19, 2A6, or 2C9 isoenzymes, particularly those with a narrow therapeutic range. Dosage adjustments as well as clinical and laboratory monitoring should be considered whenever fenofibrate is added to or withdrawn from therapy with these drugs. Patients should be monitored for the development of adverse effects.

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.