Drug Interaction Report

Coadministration with obeticholic acid may increase the plasma concentrations of omeprazole. The mechanism of interaction has not been described. Omeprazole is primarily metabolized by CYP450 2C19 and 3A4; however, obeticholic acid is not expected to significantly inhibit these pathways at recommended dosages. When a single 20 mg dose of omeprazole was administered with obeticholic acid 10 mg once daily, omeprazole peak plasma concentration (Cmax) and systemic exposure (AUC) increased by 33% and 32%, respectively. The clinical significance is unknown. Conversely, the AUC of obeticholic acid increased by less than 20%, which is not considered clinically relevant. The effect of omeprazole 40 mg once daily with obeticholic acid 10 mg once daily was not studied.

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.