Pantoprazole Sodium

Co-administration is not recommended. Pantoprazole substantially decreases atazanavir plasma concentrations, resulting in loss of therapeutic effect and development of drug resistance.

Co-administration is not recommended. Pantoprazole substantially decreases nelfinavir plasma concentrations, resulting in loss of therapeutic effect and development of drug resistance.

Concomitant use with pantoprazole sodium for injection is contraindicated. Decreased exposure of rilpivirine may reduce antiviral effect and promote drug resistance.

Concomitant use may elevate and prolong serum concentrations of methotrexate and/or hydroxymethotrexate, possibly leading to methotrexate toxicities, particularly at high doses.

Increased exposure of saquinavir when used concomitantly with pantoprazole may increase toxicity of the antiretroviral drug.

Increased INR and prothrombin time may lead to abnormal bleeding and even death. Monitor INR and prothrombin time; warfarin dose adjustment may be needed.

Pantoprazole can reduce ampicillin ester absorption by decreasing intragastric acidity, where gastric pH is important for bioavailability.

Pantoprazole may decrease absorption of dasatinib, a drug dependent on gastric pH for absorption.

Pantoprazole may decrease absorption of erlotinib, a drug dependent on gastric pH for absorption.

Pantoprazole may decrease absorption of iron salts due to increased gastric pH.

Pantoprazole can reduce ketoconazole absorption by decreasing intragastric acidity, where gastric pH is important for bioavailability.

Mycophenolate mofetil dependent on gastric pH for absorption may have decreased absorption when used with pantoprazole.

Pantoprazole may decrease absorption of nilotinib, a drug dependent on gastric pH for absorption.

Concomitant administration had no clinically important effect on exposure to active metabolite or clopidogrel-induced platelet inhibition.

ketoconazole, ampicillin esters, atazanavir, iron salts, erlotinib and mycophenolate mofetil) ( 7.4 ) May produce false-positive urine screen for THC (7.5) Methotrexate: Pantoprazole may increase serum level of methotrexate (7.6) 7.1 Interference with Antiretroviral Therapy Concomitant use of atazanavir or nelfinavir with proton pump inhibitors is not recommended. Like with other drugs that decrease the intragastric acidity, the absorption of drugs such as ketoconazole, ampicillin esters, atazanavir, iron salts, erlotinib, and mycophenolate mofetil (MMF) can decrease.

Drugs Dependent on Gastric pH for Absorption (e.g., iron salts, erlotinib, dasatinib, nilotinib, mycophenolate mofetil, ketoconazole/itraconazole) Clinical Impact: Pantoprazole can reduce the absorption of other drugs due to its effect on reducing intragastric acidity.

( 7 ) Table 3 includes drugs with clinically important drug interactions and interaction with diagnostics when administered concomitantly with pantoprazole sodium and instructions for preventing or managing them. Table 3: Clinically Relevant Interactions Affecting Drugs Co-Administered with Pantoprazole Sodium and Interaction with Diagnostics Antiretrovirals Clinical Impact: The effect of PPIs on antiretroviral drugs is variable. Decreased exposure of some antiretroviral drugs (e.g., rilpivirine atazanavir, and nelfinavir) when used concomitantly with pantoprazole sodium may reduce antiviral effect and promote the development of drug resistance.