Drug interactions
Atazanavir + Esomeprazole
Severity: Major
Atazanavir and Esomeprazole: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Atazanavir needs an acidic stomach to dissolve, so esomeprazole can markedly reduce its levels. This may lead to virologic failure and development of resistance.
What this interaction means in plain words
Atazanavir and Esomeprazole can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Atazanavir belongs to Anti Virals; Esomeprazole belongs to Gastrointestinal Tract.
Why it happens
Higher gastric pH decreases atazanavir solubility and absorption.
What to do
Avoid PPIs in treatment-experienced patients. In treatment-naive patients on ritonavir-boosted atazanavir, keep the PPI dose to an omeprazole 20 mg equivalent, give it about 12 hours before atazanavir, and monitor viral load.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Esomeprazole
- Esomeprazole + Mavacamten Contraindicated
- Esomeprazole + Rilpivirine Contraindicated
- Acalabrutinib + Esomeprazole Major
- Citalopram + Esomeprazole Major
- Clopidogrel + Esomeprazole Major
- Dacomitinib + Esomeprazole Major
Other interactions of Atazanavir
- Alfuzosin + Atazanavir Contraindicated
- Atazanavir + Avanafil Contraindicated
- Atazanavir + Dronedarone Contraindicated
- Atazanavir + Eletriptan Contraindicated
- Atazanavir + Eplerenone Contraindicated
- Atazanavir + Ergotamine Contraindicated
Frequently asked questions
Can I take Atazanavir with Esomeprazole?
MediHelp rates the interaction as major. Atazanavir and Esomeprazole can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Atazanavir needs an acidic stomach to dissolve, so esomeprazole can markedly reduce its levels. This may lead to virologic failure and development of resistance.
How serious is the interaction between Atazanavir and Esomeprazole?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid PPIs in treatment-experienced patients. In treatment-naive patients on ritonavir-boosted atazanavir, keep the PPI dose to an omeprazole 20 mg equivalent, give it about 12 hours before atazanavir, and monitor viral load.
What other medicines interact with Esomeprazole?
MediHelp also lists interactions of Esomeprazole with, for example, Mavacamten, Rilpivirine, Acalabrutinib. The full list is on the Esomeprazole page.
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