Ezolong-20, 20mg 14 tablets — Made in India — Free Delivery

Voriconazole. Omeprazole, like esomeprazole, acts as an inhibitor of CYP 2C19. The simultaneous use of omeprazole (40 mg 1 time per day) led to an increase in Cmax and AUC for voriconazole (CYP 2C19-substrate) by 15 and 41%, respectively.

Diazepam. The simultaneous use of 30 mg of esomeprazole leads to a 45% decrease in the clearance of the CYP 2C19-substrate of diazepam.

Protease inhibitors. Interaction of omeprazole with some protease inhibitors (antiretroviral preparations) has been noted. The clinical significance and mechanisms of these interactions are not always known. An increase in gastric pH during the use of omeprazole can alter the absorption of protease inhibitors. Other mechanisms of interaction are possibly associated with the inhibition of CUR 2C19. In the case of the use of some antiretroviral preparations , such as atazanavir and nelfinavir, there was a decrease in the level of the latter in the blood plasma when used simultaneously with omeprazole. Therefore, concomitant administration of omeprazole and preparations such as atazanavir and nelfinavir is not recommended. The use of omeprazole (40 mg once a day) together with atazanavir 300 mg and ritonavir 100 mg in healthy volunteers led to a significant decrease in the effect of atazanavir (approximately 75% decrease in AUC, Cmax, Cmin). Increasing the dose of atazanavir to 400 mg did not compensate for the effect of omeprazole on the efficacy of atazanavir. Increases in plasma levels of other antiretroviral agents such as saquinavir have been reported. There are also other antiretroviral preparations (darunavir, aprenavir, lopinavir) whose plasma levels remained unchanged when used concomitantly with the preparation.

Despite the similarity of the pharmacodynamic effects and pharmacokinetic properties of omeprazole and esomeprazole, it is not recommended to use esomeprazole concomitantly with atazanavir. Concomitant use of esomeprazole with nelfinavir is contraindicated.

Clopidogrel. In healthy individuals, a pharmacokinetic / pharmacodynamic interaction was observed between clopidogrel (loading dose of 300 mg / daily maintenance dose of 75 mg) and esomeprazole (40 mg / day by mouth), which led to a decrease in the exposure of the active metabolite of clopidogrel by an average of 40% and a decrease in the maximum inhibitory activity (ADP-induced) with respect to platelet aggregation by an average of 14%.

In a study involving healthy subjects, which studied the use of clopidogrel together with a combination of 20 mg of esomeprazole and 81 mg of acetylsalicylic acid compared with clopidogrel alone, a decrease in the exposure of the active metabolite of clopidogrel by almost 40% was noted. However, the maximum inhibitory activity (ATP-induced) on platelet aggregation in these individuals was the same in the groups of clopidogrel alone and clopidogrel + combination (esomeprazole + acetylsalicylic acid), which is probably due to the simultaneous administration of a low dose of acetylsalicylic acid.

A number of observational and clinical studies on pharmacokinetic / pharmacodynamic interactions have shown conflicting results as to whether the risk of major cardiovascular events is increased if a patient is given clopidogrel along with a PPI. As a precaution, it is recommended to avoid the simultaneous use of clopidogrel.

Medicines that are metabolized by CYP 2C19. Esomeprazole inhibits CYP 2C19, the main enzyme that metabolizes esomeprazole. Therefore, when using esomeprazole in combination with preparations metabolized by CYP 2C19 (such as diazepam, citalopram, imipramine, clomipramine, phenytoin), the concentration of these preparations in the blood plasma may be increased, so a decrease in their dose may be required. This circumstance should be taken into account, especially when prescribing esomeprazole as needed.

Medicines whose absorption is pH dependent. The decreased acidity of gastric juice when using esomeprazole can increase or decrease the absorption of preparations if their absorption depends on the acidity of the gastric juice.

As with other preparations that reduce intragastric acidity, absorption of preparations such as ketoconazole, itraconazole, and erlotinib may be decreased, while absorption of preparations such as digoxin may be increased with esomeprazole. The simultaneous use of omeprazole (20 mg / day) and digoxin in healthy individuals increased the bioavailability of digoxin by 10% (in two out of ten people - by 30%). Digoxin toxicity has been rarely reported. But despite this, care must be taken when using high doses of esomeprazole in elderly patients. Enhanced therapeutic preparation monitoring of digoxin should be performed.

Methotrexate. Increased blood levels of methotrexate have been reported in some patients when taken with PPIs. If it is necessary to administer high doses of methotrexate, consider temporarily discontinuing esomeprazole.