Drug interactions
Esomeprazole + Sofosbuvir-velpatasvir
Severity: Major
Esomeprazole and Sofosbuvir-velpatasvir: 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
Esomeprazole suppresses gastric acid, which reduces velpatasvir solubility and absorption. Lower exposure may reduce the chance of virologic cure. Labeling does not recommend PPI coadministration.
What this interaction means in plain words
Esomeprazole and Sofosbuvir-velpatasvir 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; Sofosbuvir-velpatasvir belongs to Anti Virals.
Why it happens
Increased gastric pH reduces velpatasvir dissolution and oral bioavailability.
What to do
Avoid PPIs during therapy where possible, substituting an H2 blocker at a modest dose given simultaneously with or 12 hours apart from the antiviral. If a PPI is medically necessary, give the antiviral with food 4 hours before the PPI at no more than omeprazole 20 mg equivalent.
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?
Pro+ members
Unlock the full page
Create an account and start a Pro+ trial to unlock the full management advice for Esomeprazole and Sofosbuvir-velpatasvir, the additional notes, the evidence detail and the whole-prescription interaction checker.
- Full clinical management advice
- Additional notes
- Evidence detail
- Interaction checker for a whole prescription
Try Pro+ free for 7 days on the web. No card needed.
References
Other interactions of Sofosbuvir-velpatasvir
- Rifampin + Sofosbuvir-velpatasvir Contraindicated
- Rifapentine + Sofosbuvir-velpatasvir Contraindicated
- Sofosbuvir-velpatasvir + St john's wort Contraindicated
- Amiodarone + Sofosbuvir-velpatasvir Major
- Apalutamide + Sofosbuvir-velpatasvir Major
- Carbamazepine + Sofosbuvir-velpatasvir Major
Other interactions of Esomeprazole
- Esomeprazole + Mavacamten Contraindicated
- Esomeprazole + Rilpivirine Contraindicated
- Acalabrutinib + Esomeprazole Major
- Atazanavir + Esomeprazole Major
- Citalopram + Esomeprazole Major
- Clopidogrel + Esomeprazole Major
Frequently asked questions
Can I take Esomeprazole with Sofosbuvir-velpatasvir?
MediHelp rates the interaction as major. Esomeprazole and Sofosbuvir-velpatasvir 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 suppresses gastric acid, which reduces velpatasvir solubility and absorption. Lower exposure may reduce the chance of virologic cure. Labeling does not recommend PPI coadministration.
How serious is the interaction between Esomeprazole and Sofosbuvir-velpatasvir?
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 during therapy where possible, substituting an H2 blocker at a modest dose given simultaneously with or 12 hours apart from the antiviral. If a PPI is medically necessary, give the antiviral with food 4 hours before the PPI at no more than omeprazole 20 mg equivalent.
What other medicines interact with Sofosbuvir-velpatasvir?
MediHelp also lists interactions of Sofosbuvir-velpatasvir with, for example, Rifampin, Rifapentine, St john's wort. The full list is on the Sofosbuvir-velpatasvir page.
Full monographs, dosing and an interaction checker in the MediHelp app
Open the complete reference, check multi-drug interactions and use dosing tools in the MediHelp app.
