Table 2. Manufacturers’ information about drug interactions of proton pump inhibitors.
| Indication | Type of interaction | OmeprazoleEsomeprazole | Lansoprazole | Rabeprazole | Pantoprazole |
|---|---|---|---|---|---|
| Treating anxiety | increased plasma levels | Benzodiazepines,e.g. diazepam | |||
|
Anticoagulation Vitamin K antagonists Antiplatelet therapy |
increased plasma levels reduced activation of prodrug |
Phenprocoumon Warfarin Clopidogrel |
Clopidogrel |
Clopidogrel |
Phenprocoumon Warfarin Clopidogrel |
| Depression | reduced PPI levels increased plasma levels |
St. John’s wort Citalopram Clomipramine Imipramine |
St. John’s wort Fluvoxamine |
||
| Diabetes | Glibenclamide Tolbutamide |
||||
| Epilepsy | increased plasma levels | Phenytoin | |||
|
Infectious diseasesHIV Bacteria Mycoses |
severely reduced plasma levels; thus, PPIs contraindicated absorption reduced with acid deficiency azole antifungals inhibit the metabolism of PPIs |
Atazanavir Nelfinavir Saquinavir Rifampicin Itraconazole Ketoconazole Posaconazole Voriconazoel |
Atazanavir Erythromycin Rifampicin Itraconazole Ketoconazole |
Atazanavir Itraconazole Ketoconazole |
Atazanavir Itraconazole Ketoconazole Posaconazole |
| Immunosuppressants | Conflicting data: increased plasma levels possible |
Cyclosporine Tacrolimus |
Tacrolimus | ||
| Cardiology | 10% higher digoxin levelsalong with increased pH | Digoxin | Digoxin | ||
| Oncology | decreased plasma levels questionable increased plasma levels, delayed elimination | Erlotinib Methotrexate in high doses |
Erlotinib | ||
| Reflux disease | reduced absorption of PPIs | Antacids Sucralfate |
Antacids |
The information presented in this table is derived from the patient information leaflets of the manufacturers of proton pump inhibitors (PPIs) producing PPIs as follow-on and generic products. A different listing of medications in this table does not mean that this interaction has been excluded for the respective PPI. Not all listed drugs are included in the package leaflets of each manufacturer. Less drug interactions are reported for pantoprazole (e15) because of its lower level of interaction with CYP2C19. However, with regard to interactions basically the same drugs are listed.