Proton Pump Inhibitor
Esomeprazole: Drug Interactions
Esomeprazole is a proton pump inhibitor (PPI) that reduces gastric acid production and is used to treat acid reflux, GERD, and peptic ulcers.
PPIs interact with drugs requiring acidic environment for absorption and share CYP2C19 metabolic pathway with clopidogrel.
Major Interactions — Avoid or Monitor Closely
- ⚠Clopidogrel — CYP2C19 inhibition by PPIs (especially omeprazole, esomeprazole) reduces conversion to active metabolite; potentially reduces antiplatelet effect; pantoprazole preferred if PPI required
- ⚠High-dose methotrexate — PPIs reduce renal tubular secretion of methotrexate, increasing toxicity risk; consider temporary PPI suspension before high-dose methotrexate infusion
Moderate Interactions — Use With Caution
- •Ketoconazole, itraconazole, posaconazole — reduced absorption due to decreased gastric acidity
- •Atazanavir, nelfinavir (HIV antiretrovirals) — absorption reduced by elevated gastric pH; avoid or use lowest PPI dose
- •Digoxin — reduced renal excretion with long-term PPI use; monitor digoxin levels
- •Tacrolimus — CYP3A4 competition; monitor tacrolimus levels
- •Iron and calcium supplements — reduced absorption with chronic acid suppression; take 2 hours apart
- •Vitamin B12 — chronic PPI use reduces B12 absorption; check levels annually with long-term use
Food & Drink Interactions
- •Best taken 30–60 minutes before first meal — proton pumps active during eating
- •Magnesium-rich foods — chronic PPIs cause hypomagnesemia; magnesium supplements may be required
Monitoring Requirements
Serum magnesium (long-term use >1 year); bone density in elderly long-term users; B12 levels; Clostridioides difficile infection risk; review indication annually and deprescribe when no longer required
Conditions Treated with Esomeprazole
Questions about your medication?
Our AI Symptom Checker analyses your symptoms and suggests the most likely diagnoses — including relevant medications.
Use AI Symptom Checker →