Proton Pump Inhibitors/Select CYP2C19 and CYP3A4 Inducers Interactions

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.

Medical warning:

Moderate. These medicines may cause some risk when taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.

How the interaction occurs:

Apalutamide, enzalutamide, rifampin, or St. John's wort may speed up how quickly your liver processes your proton pump inhibitor.

What might happen:

The amount of proton pump inhibitor in your blood may decrease and it may not work as well.

What you should do about this interaction:

Let your healthcare professionals (e.g. doctor or pharmacist) know that you are taking these medicines together. Contact your healthcare provider if your proton pump inhibitor does not seem to be working as well for your stomach condition.Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.

  • 1.Nexium (esomeprazole magnesium) US prescribing information. AstraZeneca Pharmaceuticals LP June, 2018.
  • 2.This information is based on or an extract from the UW Metabolism and Transport Drug Interaction Database (DIDB) Platform, Copyright University of Washington 1999-2014..
  • 3.Xtandi (enzalutamide) US prescribing information. Astellas Pharma US, Inc. October, 2016.
  • 4.Erleada (apalutamide) US prescribing information. Janssen Biotech, Inc. February, 2018.
  • 5.Bosilkovska M, Samer CF, Deglon J, Rebsamen M, Staub C, Dayer P, Walder B, Desmeules JA, Daali Y. Geneva cocktail for cytochrome p450 and P-glycoprotein activity assessment using dried blood spots. Clin Pharmacol Ther 2014 Sep;96(3):349-59.
  • 6.Wang LS, Zhou G, Zhu B, Wu J, Wang JG, Abd El-Aty AM, Li T, Liu J, Yang TL, Wang D, Zhong XY, Zhou HH. St John's wort induces both cytochrome P450 3A4-catalyzed sulfoxidation and 2C19-dependent hydroxylation of omeprazole. Clin Pharmacol Ther 2004 Mar;75(3):191-7.
  • 7.Xie HG. Additional discussions regarding the altered metabolism and transport of omeprazole after long-term use of St John's wort. Clin Pharmacol Ther 2005 Oct;78(4):440-1.

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CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.