Omeprazole
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Proton pump inhibitors (PPIs) have been used for many years and are commonly prescribed for acid related conditions such as heartburn, GORD and stomach ulcers. They reduce the amount of acid produced in the stomach. PPI interactions can happen in different ways. Some medicines need stomach acid to be absorbed properly, while others can interact with the enzymes that break down certain PPIs. This is particularly important with medicines such as clopidogrel and rilpivirine.
For adults in the UK who use or are considering a PPI and also take other medicines, this guide explains what PPIs are, which medicines are in this group, how interactions can happen and which combinations need extra care. This includes blood thinning medicines, HIV treatment, antifungals, cancer medicines, heart medicines, supplements and antacids.
Some interactions can reduce how well another medicine works or increase the chance of side effects. That is why it is important to tell your prescriber or pharmacist about all the medicines and supplements you take before starting a PPI.
Treatment suitability depends on your individual circumstances. Your prescriber can review your medicines and check whether the PPI you are taking is appropriate.
What Is a PPI Medication?
A PPI, or proton pump inhibitor, is a type of medicine that reduces the amount of acid your stomach produces. It works by blocking an enzyme system called the hydrogen potassium ATPase pump in the cells that produce stomach acid.
PPIs are used to treat conditions such as gastro oesophageal reflux disease (GORD), heartburn, indigestion, stomach ulcers and duodenal ulcers. They can also be used with antibiotics as part of treatment for H. pylori infection. Common PPIs used in the UK include omeprazole, esomeprazole, lansoprazole, pantoprazole and rabeprazole.
PPI Drugs List: What Medications Are PPIs?
Several PPIs are available in the UK. Knowing which medicines belong to this group can make interaction information easier to understand, although the exact interactions can vary between individual PPIs.
| PPI (generic name) | Common brand names |
|---|---|
| Omeprazole | Losec, Losec MUPS |
| Esomeprazole | Nexium |
| Lansoprazole | Zoton FasTab |
| Pantoprazole | Protium |
| Rabeprazole | Pariet |
All PPIs reduce stomach acid, but they are not identical when it comes to drug interactions. For example, omeprazole and esomeprazole have an important interaction with clopidogrel. When clopidogrel is needed, NHS Specialist Pharmacy Service guidance recommends using lansoprazole, pantoprazole or rabeprazole instead of omeprazole or esomeprazole.
How PPIs Interact With Other Medications
PPI interactions can happen for several reasons.
One is a change in stomach acidity. Some medicines need an acidic environment in the stomach to be absorbed properly. Because PPIs reduce stomach acid, they can sometimes reduce the absorption of these medicines.
Another involves enzymes in the liver. Omeprazole and esomeprazole can affect an enzyme called CYP2C19. Some medicines, including clopidogrel, rely on this enzyme as part of the way they are processed in the body.
The interaction depends on the particular PPI and medicine involved. It is therefore not accurate to assume that all PPIs have the same interaction risk.
Blood Thinning Medication Interactions
Clopidogrel is an antiplatelet medicine used to help prevent blood clots. It needs to be activated partly through the CYP2C19 enzyme. Omeprazole and esomeprazole can interfere with this process and reduce the amount of active clopidogrel in the body.
NHS Specialist Pharmacy Service guidance advises avoiding omeprazole and esomeprazole with clopidogrel because of this significant interaction. Lansoprazole, pantoprazole and rabeprazole are preferred options when a PPI is needed.
This does not mean that people taking clopidogrel should avoid PPIs altogether. PPIs may be prescribed to help protect the stomach in people taking clopidogrel who have a higher risk of gastrointestinal problems. The important point is choosing an appropriate PPI.
Warfarin is different. There is no general recommendation to avoid all PPIs with warfarin, but people taking warfarin need regular INR monitoring. Tell your healthcare professional when you start or stop any medicine, including a PPI, so they can decide whether any additional monitoring is needed.
HIV Medication Interactions: Rilpivirine and Atazanavir
Rilpivirine is an antiretroviral medicine used to treat HIV. It needs an acidic stomach environment for adequate absorption. PPIs increase stomach pH and can significantly reduce rilpivirine levels.
UK prescribing information states that oral rilpivirine should not be taken with PPIs because the combination can reduce rilpivirine exposure and may affect its treatment effect. This applies to PPIs including omeprazole, esomeprazole, lansoprazole, pantoprazole and rabeprazole.
Atazanavir is another HIV medicine affected by changes in stomach acidity. The advice depends on the particular HIV treatment combination and dose. If you take atazanavir or another HIV medicine, your HIV specialist should be involved before a PPI is started or changed.
If you take HIV treatment, make sure both your HIV specialist and any other prescriber know about all the medicines you are taking.
Antifungal and Antibiotic Interactions
Some antifungal medicines, including ketoconazole and itraconazole, can be affected by reduced stomach acidity. PPIs may reduce their absorption, which can affect how much medicine reaches the bloodstream.
If you need an antifungal medicine while taking a PPI, tell your pharmacist or prescriber. They can check the particular antifungal and decide whether the timing, formulation or treatment needs to be changed.
There is no single interaction rule that applies to all antibiotics. Many commonly used antibiotics can be taken with PPIs, but the exact combination still matters. Give your pharmacist or prescriber a complete list of your medicines so they can check the specific antibiotic you have been prescribed.
Cancer Treatment Interactions
Some cancer medicines can be affected by changes in stomach acidity. Erlotinib, for example, requires an acidic environment for absorption, so medicines that significantly reduce stomach acid can lower its exposure.
Other oral cancer medicines may also have specific interaction warnings. The advice can vary considerably depending on the medicine and cancer treatment plan.
If you are receiving cancer treatment, tell your oncology team about any PPI you take, including one bought from a pharmacy. Your oncology team can check the specific combination rather than assuming that every PPI has the same effect.
Heart Medication Interactions
Digoxin is a medicine used for certain heart conditions. Omeprazole can increase the bioavailability of digoxin, meaning that more of the medicine may become available in the body. Your prescriber may consider monitoring if these medicines are started together, particularly if there are other factors that could affect digoxin levels.
Do not change your digoxin dose yourself. If you take digoxin and need a PPI, your prescriber or pharmacist can check the combination and advise whether any monitoring is needed.
PPIs are also sometimes prescribed alongside medicines such as aspirin or other medicines that can increase the risk of stomach problems. The reason for using the PPI in these cases may be to reduce the risk of gastrointestinal complications.
Supplement and Nutrient Interactions
Long term PPI treatment can affect the absorption or levels of some nutrients. These include vitamin B12, magnesium, iron and, in some circumstances, calcium.
This does not mean that everyone taking a PPI needs supplements. Whether you need a blood test or supplementation depends on your health, diet, other medicines and how long you have been taking the PPI.
If you take vitamins, minerals or other supplements, tell your pharmacist or prescriber. This is especially useful if you take several supplements or are using them to manage a particular health problem.
On glutamine specifically, there is no well established interaction between glutamine supplements and PPIs. However, information about supplements can be more limited than information about prescription medicines, so it is still worth telling your healthcare professional what you take.
Can You Take PPIs and Antacids Together?
PPIs and antacids can generally be used as part of the same treatment plan. NHS guidance states that Gaviscon can be taken with a PPI such as lansoprazole. They work in different ways: PPIs reduce the amount of acid your stomach produces, while antacids neutralise stomach acid. Gaviscon also forms a protective layer that can help prevent stomach contents from moving back up into the food pipe.
However, antacids can affect the absorption of other medicines. NHS guidance advises leaving a gap of 2 to 4 hours between taking an antacid and other medicines in many cases. The exact timing depends on the medicine and the antacid, so check the product leaflet or ask a pharmacist.
Can you take Rennies with lansoprazole? They can generally be used together, but Rennie is an antacid and can affect the absorption of some other medicines. If you take several medicines, ask a pharmacist whether you should separate the doses.
Can You Take Two PPIs Together? Omeprazole and Nexium
Can you take omeprazole and Nexium together? Nexium is a brand name for esomeprazole, which is another PPI closely related to omeprazole.
Taking two PPIs together is not standard treatment. There is generally no reason to combine them simply because one PPI does not seem to be working well enough. If your symptoms are not controlled, your prescriber may review the dose, check how you are taking the medicine or consider whether another treatment is more appropriate.
Do not add a second PPI yourself unless your prescriber specifically tells you to do so.
PPI Interaction Summary Table
| Medicine or substance | Nature of interaction |
|---|---|
| Clopidogrel | Omeprazole and esomeprazole can reduce clopidogrel activation. Lansoprazole, pantoprazole or rabeprazole are generally preferred when a PPI is needed. |
| Warfarin | No general recommendation to avoid all PPIs, but routine INR monitoring and medicine reviews remain important. |
| Rilpivirine (HIV) | Oral rilpivirine should not be taken with PPIs because reduced absorption can affect treatment. |
| Atazanavir (HIV) | Reduced stomach acid can affect absorption. Specialist advice is needed. |
| Ketoconazole, itraconazole | Absorption can be reduced when stomach acid is lowered. |
| Erlotinib | Reduced stomach acid can reduce absorption. |
| Digoxin | Omeprazole can increase digoxin exposure. Monitoring may be considered in some people. |
| Vitamin B12, iron, calcium, magnesium | Long term PPI treatment can affect levels or absorption in some people. |
| Antacids such as Gaviscon and Rennies | Can be used with PPIs, but antacids can affect the absorption of other medicines, so timing may matter. |
This table is a general guide and does not cover every possible interaction. Always give your prescriber or pharmacist a complete list of your medicines, vitamins and supplements.
Safe PPI Use and Side Effects: What to Tell Your Prescriber
Before starting a PPI through EverydayMeds, tell your prescriber about every medicine, supplement and herbal remedy you take, including products bought from a pharmacy or shop.
This is particularly important if you take clopidogrel, HIV medicines, certain antifungals, cancer treatment or digoxin. Some combinations may need a different PPI, additional monitoring or another treatment altogether.
If you take several medicines and are worried about interactions, a pharmacist can also review your medication list with you.
Available PPI Treatment Options
EverydayMeds stocks omeprazole 20mg capsules and Losec MUPS 20mg tablets, alongside lansoprazole 15mg capsules and orodispersible tablets, pantoprazole, esomeprazole and rabeprazole.
The choice of PPI can depend on your condition, other medicines you take and any previous side effects. If a PPI interaction is a concern, your prescriber can assess whether another PPI or a different type of medicine, such as famotidine, may be appropriate.
Common side effects of PPIs can include headache, stomach pain, nausea, vomiting, diarrhoea, constipation and wind. If you develop symptoms that concern you or side effects that do not settle, speak to a pharmacist, GP or prescriber.
How to Get a PPI Through EverydayMeds
Getting a PPI through EverydayMeds starts with a short online questionnaire about your symptoms and current medicines. A UK registered prescriber reviews the information and checks whether treatment is appropriate, including any relevant medicine interactions.
If you are unsure about a medicine or supplement you take, include it in your questionnaire so the prescriber has as much information as possible when reviewing your treatment.
