Drug Interaction Report

The coadministration of esomeprazole and drugs that are substrates of the CYP450 2C19 enzymatic pathway may result in elevated plasma concentrations of those drugs. The mechanism is decreased clearance due to competitive inhibition of CYP450 2C19 activity by esomeprazole. The clinical significance of this potential interaction, if any, is unknown. Caution is advised if esomeprazole is used concomitantly with medications that undergo metabolism by CYP450 2C19, particularly those with a narrow therapeutic range.

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.

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.