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Pantoprazole and other proton pump inhibitors are metabolized by the cytochrome P450 system, primarily by isoenzyme CYP2C19, and may alter the metabolism of some drugs metabolize by these enzymes. Pantoprazole may prolong the elimination of diazepam, phenytoin, tolbutamide, and warfarin. Pantoprazole and other proton pump inhibitors can reduce the absorption of drugs such as ketoconazole, and possibly itraconazole, whose absorption is dependent on an acid gastric pH.
With voriconazole, the plasma concentration of both drugs may be increased and a reduced dose of pantoprazole is recommended.
