Takepron OD Drug Interactions

Drugs with pH-Dependent Absorption: Due to its effects on gastric acid secretion, lansoprazole can reduce the absorption of drugs where gastric pH is an important determinant of their bioavailability. As with other drugs that decrease the intragastric acidity, the absorption of drugs such as ampicillin esters, ketoconazole, atazanavir, nelfinavir, iron salts, erlotinib, and mycophenolate mofetil (MMF) can decrease, while the absorption of drugs such as digoxin can increase during treatment with TAKEPRON (see Pharmacology: Pharmacokinetics under Actions).
TAKEPRON is likely to substantially decrease the systemic concentrations of HIV protease inhibitors such as atazanavir and nelfinavir, which are dependent upon the presence of gastric acid for absorption, and may result in a loss of therapeutic effect of atazanavir or nelfinavir and the development of HIV resistance. Therefore, TAKEPRON should not be co-administered with atazanavir or nelfinavir (see Pharmacology: Pharmacokinetics under Actions).
Co-administration of PPIs in healthy subjects and in transplant patients receiving MMF has been reported to reduce the exposure to the active metabolite, mycophenolic acid (MPA), possibly due to a decrease in MMF solubility at an increased gastric pH. The clinical relevance of reduced MPA exposure on organ rejection has not been established in transplant patients receiving PPIs and MMF. Use TAKEPRON with caution in transplant patients receiving MMF.
Warfarin: In a study of healthy subjects, co-administration of single or multiple 60 mg doses of TAKEPRON and warfarin did not affect the pharmacokinetics of warfarin nor prothrombin time (see Pharmacology: Pharmacokinetics under Actions). However, there have been reports of increased INR and prothrombin time in patients receiving PPIs and warfarin concomitantly. Increases in INR and prothrombin time may lead to abnormal bleeding and even death. Patients treated with PPIs and warfarin concomitantly may need to be monitored for increases in INR and prothrombin time (see Pharmacology: Pharmacokinetics under Actions).
Tacrolimus: Concomitant administration of lansoprazole and tacrolimus may increase whole blood levels of tacrolimus, especially in transplant patients who are intermediate or poor metabolizers of CYP2C19.
Theophylline: A minor increase (10%) in the clearance of theophylline was observed following the administration of TAKEPRON concomitantly with theophylline. Although the magnitude of the effect on theophylline clearance is small, individual patients may require additional titration of their theophylline dosage when TAKEPRON is started or stopped to ensure clinically effective blood levels (see Pharmacology: Pharmacokinetics under Actions).
Clopidogrel: Concomitant administration of lansoprazole and clopidogrel in healthy subjects had no clinically important effect on exposure to the active metabolite of clopidogrel or clopidogrel-induced platelet inhibition (see Pharmacology: Pharmacokinetics under Actions). No dose adjustment of clopidogrel is necessary when administered with an approved dose of TAKEPRON.
Methotrexate: Case reports, published population pharmacokinetic studies, and retrospective analyses suggest that concomitant administration of PPIs and methotrexate (primarily at high dose; see methotrexate prescribing information) may elevate and prolong serum levels of methotrexate and/or its metabolite hydroxymethotrexate. However, no formal drug interaction studies of high dose methotrexate with PPIs have been conducted (see Concomitant Use of TAKEPRON with Methotrexate under Precautions)
In a study of rheumatoid arthritis patients receiving low-dose methotrexate, TAKEPRON and naproxen, no effect on pharmacokinetics of methotrexate was observed (see Pharmacology: Pharmacokinetics under Actions).
Combination Therapy with Clarithromycin: Concomitant administration of clarithromycin with other drugs can lead to serious adverse reactions due to drug interactions [see Warnings and Precautions in prescribing information for clarithromycin]. Because of these drug interactions, clarithromycin is contraindicated for coadministration with certain drugs [see Contraindications in prescribing information for clarithromycin].
For information about drug interactions of antibacterial agents (amoxicillin and clarithromycin) indicated in combination with TAKEPRON, refer to the Interactions section of their prescribing information.