What the FDA labels say about taking them together
Esomeprazole and ketoconazole
Esomeprazole's FDA label of March 19, 2024 names ketoconazole in its drug interactions (prescription label) section; the ketoconazole label PlainMeds reads does not name esomeprazole. The esomeprazole label: “Esomeprazole can reduce the absorption of other drugs due to its effect on reducing intragastric acidity”
Check it at the source: the esomeprazole FDA label on DailyMed (effective March 19, 2024, Haleon US Holdings LLC); the ketoconazole FDA label on DailyMed (effective January 28, 2026, E. Fougera & Co. a division of Fougera Pharmaceuticals, LLC).
What does the esomeprazole label say about ketoconazole?
Esomeprazole label, drug interactions (prescription label)Clinical Impact: Esomeprazole can reduce the absorption of other drugs due to its effect on reducing intragastric acidity Intervention: Mycophenolate mofetil (MMF): Co-administration of omeprazole, of which esomeprazole is an enantiomer, in healthy subjects and in transplant patients receiving MMF has been reported to reduce the exposure to the active metabolite, mycophenolic acid (MPA), possibly due to a decrease in MMF …
Esomeprazole Strontium label (R2 Pharma, LLC, September 22, 2016), drug interactionsLike with other drugs that decrease the intragastric acidity, the absorption of drugs such as ketoconazole, atazanavir, iron salts, erlotinib, and mycophenolate mofetil (MMF) can decrease, while the absorption of drugs such as digoxin can increase during treatment with omeprazole.
Source: FDA drug label (Esomeprazole Strontium, NDA202342), R2 Pharma, LLC, effective September 22, 2016 (SPL set 3c916d32-f9e9-1d15-e054-00144ff88e88), via openFDA
Source: FDA drug label (Nexium 24HR), NDA204655 (Astrazeneca Lp), as published by Haleon US Holdings LLC, effective March 19, 2024 (SPL set 4513934d-0cf0-40fc-a348-b4e75a33b094), via openFDA; the full label on DailyMed
What does the ketoconazole label say about esomeprazole?
Ketoconazole's label (effective January 28, 2026) does not name esomeprazole in these sections. A label lists what its studies and reports found; it is not a complete list.
Source: FDA drug label (ketoconazole), E. Fougera & Co. a division of Fougera Pharmaceuticals, LLC, effective January 28, 2026 (SPL set cad7c647-34a9-4e4e-83b3-8d78e58f588f), via openFDA; the full label on DailyMed
These are the labels' own sentences. PlainMeds does not grade interactions; a pharmacist or prescriber can say what they mean for one person's medicines.
Both medicines on the record
| Esomeprazole | Ketoconazole | |
|---|---|---|
| Labeled for | Acid reflux and ulcers | Fungal infections |
| Boxed warning | No | No |
| Pharmacy cost (NADAC) | $0.145 per capsule 20 mg capsule | $0.249 per gram 2% cream |
| Shortage now | No current entry | No current entry |
Source: FDA NDC Directory, CMS NADAC of October 7, 2026 and the FDA Drug Shortage Database (FDA files October 8, 2026)
What next?
- Check more medicines together
- up to five at once