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Clinically Important Drug Interactions with PPIs Reduced absorption due to gastric pH Azoles: Ketoconazole, Itraconazole, Posaconazole (oral) Antiretrovirals: Atazanavir , Rilpivirine Oral anticancer drugs (pH-dependent) Erlotinib, Gefitinib, Dasatinib, Nilotinib Iron salts, Calcium carbonate Mycophenolate mofetil Increased exposure / toxicity High-dose Methotrexate delayed clearance & toxicity Warfarin INR (monitor closely) Phenytoin, Diazepam Long-term safety concerns Hypomagnesemia (higher risk with diuretics) Clostridioides difficile infection Fracture risk with prolonged use Clinical Pearl Avoid unnecessary PPIs in patients receiving pH-dependent oral anticancer therapies

Baker FC, de Zambotti M, Colrain IM, Bei B

Two main factors were identified as a potential origin of the increased variation in relative mean TW CCS N2, meas shifts following phase II biotransformation: (i) bulky entities could exist in different gas phase conformations and (ii) the site of conjugation can further influence changes in relative mean TW CCS N2, meas values

Immunity IV Strengthens immune defenses and supports recovery