Drug interactions
Esomeprazole + Neratinib
Severity: Major
Esomeprazole and Neratinib: major interaction.
Last updated Sources: US FDA label
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
Neratinib absorption is reduced at higher gastric pH, so esomeprazole may lower its exposure and effectiveness.
What this interaction means in plain words
Esomeprazole and Neratinib 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.
Esomeprazole belongs to Gastrointestinal Tract; Neratinib belongs to Oncology.
Why it happens
Higher gastric pH decreases the solubility and absorption of neratinib.
What to do
Avoid PPIs with neratinib. If acid suppression is needed, take neratinib at least 3 hours after an antacid, or use an H2 blocker with neratinib taken at least 2 hours before it or 10 hours after it.
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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References
Other interactions of Esomeprazole
- Esomeprazole + Mavacamten Contraindicated
- Esomeprazole + Rilpivirine Contraindicated
- Acalabrutinib + Esomeprazole Major
- Atazanavir + Esomeprazole Major
- Citalopram + Esomeprazole Major
- Clopidogrel + Esomeprazole Major
Other interactions of Neratinib
- Amiodarone + Neratinib Major
- Amobarbital + Neratinib Major
- Aprepitant + Neratinib Major
- Armodafinil + Neratinib Major
- Bosentan + Neratinib Major
- Carbamazepine + Neratinib Major
Frequently asked questions
Can I take Esomeprazole with Neratinib?
MediHelp rates the interaction as major. Esomeprazole and Neratinib 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. Neratinib absorption is reduced at higher gastric pH, so esomeprazole may lower its exposure and effectiveness.
How serious is the interaction between Esomeprazole and Neratinib?
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 with neratinib. If acid suppression is needed, take neratinib at least 3 hours after an antacid, or use an H2 blocker with neratinib taken at least 2 hours before it or 10 hours after it.
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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