Drug General Information (ID: DDI0GFA71R)
Drug Name			Nelfinavir		Drug Info		Esomeprazole		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Protease Inhibitors				Antiulcer Agents
Structure

Mechanism of Nelfinavir-Esomeprazole Interaction (Severity Level: Major)
Altered gastric pH Click to Show/Hide Mechanism Graph
Drug Name		Nelfinavir				Esomeprazole
Mechanism		Gastric pH sensitive				Gastric alkalinizer
Key Mechanism Factor 1
		Factor Name		Gastric pH
		Factor Description		The normal pH range of gastric acid is between 1.5 and 3.5 and is highly acidic, consisting mainly of hydrochloric acid. Changes in the pH of the stomach can alter the absorption of drugs.
Mechanism Description		Decreased absorption of Nelfinavir due to altered gastric pH caused by Esomeprazole

Recommended Action
Management		Given the risk of reduced viral susceptibility and resistance development associated with subtherapeutic antiretroviral drug levels, use of proton pump inhibitors is not recommended in patients treated with nelfinavir.

References
1	Cerner Multum, Inc. "UK Summary of Product Characteristics.".
2	Fang AF, Damle BD, Labadie RR, Crownover PH, Hewlett D, Glue PW "Significant decrease in nelfinavir systemic exposure after omeprazole coadministration in healthy subjects." Pharmacotherapy 28 (2008): 42-50. [PMID: 18154473]
3	Product Information. Viracept (nelfinavir). Agouron Pharma Inc, La Jolla, CA.
4	Durant J, Clevenbergh P, Garraffo R, Halfon P, Icard S, DelGiudice P, Montagne N, Schapiro JM, Dellamonica P "Importance of protease inhibitor plasma levels in HIV-infected patients treated with genotypic-guided therapy: pharmacological data from the Viradapt Study." Aids 14 (2000): 1333-9. [PMID: 10930147]