Drug interactions
Esomeprazole + Sofosbuvir / velpatasvir
Severity: Major
Esomeprazole and Sofosbuvir / velpatasvir: 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
Velpatasvir dissolves poorly at higher gastric pH, so esomeprazole may substantially reduce its absorption. This may lower hepatitis C cure rates.
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.
Why it happens
Higher gastric pH decreases velpatasvir solubility and oral absorption.
What to do
Avoid coadministration where possible. If a PPI is essential, give sofosbuvir/velpatasvir with food 4 hours before the PPI, at a dose not exceeding an omeprazole 20 mg equivalent, and consider using an H2 blocker or antacid instead.
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
- 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. Velpatasvir dissolves poorly at higher gastric pH, so esomeprazole may substantially reduce its absorption. This may lower hepatitis C cure rates.
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 coadministration where possible. If a PPI is essential, give sofosbuvir/velpatasvir with food 4 hours before the PPI, at a dose not exceeding an omeprazole 20 mg equivalent, and consider using an H2 blocker or antacid instead.
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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