Nexium (Esomeprazole Powder for Suspension) and Xatmep

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Talk to your doctor before using methotrexate together with esomeprazole. Using these medications together can increase the blood levels and side effects of methotrexate. Your doctor or pharmacist may be able to offer suggestions on safer alternatives if you require treatment for stomach acid or ulcer while you are being treated with methotrexate. However, if your doctor does prescribe these medications together, you may need a dose adjustment or special tests to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

MONITOR CLOSELY: Coadministration with proton pump inhibitors (PPIs) may increase the serum concentrations of methotrexate (MTX) and its potentially active 7-hydroxy metabolite. The proposed mechanism is PPI inhibition of the active tubular secretion of MTX and 7-hydroxymethotrexate via renal H+/K+ ATPase pumps. Inhibition of the breast cancer resistance protein (BCRP)-mediated transport of methotrexate and 7-hydroxymethotrexate by the proton pump inhibitors has also been suggested. The interaction was suspected in 2 case reports involving omeprazole and high-dose MTX cycles, where elimination of MTX was significantly delayed during cycles with omeprazole but became normal during subsequent cycles after omeprazole was discontinued or substituted with ranitidine. In another case, coadministration of pantoprazole and low-dose pulse MTX (15 mg IM once a week) resulted in severe myalgia and bone pain for several days following each of five MTX injections. The symptoms subsided dramatically and eventually disappeared after pantoprazole was replaced with ranitidine. A subsequent rechallenge led to reappearance of symptoms. Although the pharmacokinetics of MTX were not affected, systemic exposure (AUC) of 7-hydroxymethotrexate was significantly increased by 70% and half-life was doubled in the presence of pantoprazole.

MANAGEMENT: Proton pump inhibitor therapy should preferably be stopped several days prior to administration of methotrexate. In addition, it is not generally recommended to use proton pump inhibitors with high-dose methotrexate therapy, particularly in the presence of renal impairment. If concomitant use is necessary, clinicians should consider the potential for interaction and closely monitor methotrexate serum levels and toxicity. Use of an H2 antagonist may also be an appropriate alternative. It is not known if the interaction occurs with low, oral doses of methotrexate used to treat rheumatoid arthritis.

Nexium (Esomeprazole Powder for Suspension)

Generic Name: esomeprazole

Brand name: Nexium, Esomeprazole Strontium, Nexium, NexIUM 24HR, Nexium IV

Synonyms: Nexium

What is Nexium (Esomeprazole Powder for Suspension)?

Xatmep

Generic Name: methotrexate

Brand name: Rheumatrex Dose Pack, Trexall, Xatmep, Otrexup, Rasuvo, Methotrexate Sodium, Preservative Free

Synonyms: n.a.

What is Xatmep?