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Dexlansoprazole by increasing gastric pH may decrease the solubility, absorption, and plasma concentration of ledipasvir .
Ledipasvir : P-gp and BCRP; primarily excreted (>98%) unchanged in the feces, with little renal excretion, P-gp / Sofosbuvir : P-gp and BCRP; rapidly converted to the predominant circulating metabolite GS-331007 that accounts for greater than 90% of drug related material systemic exposure.
Ledipasvir : P-gp and BCRP (intestinal weak), OATP1B1/1B3, BSEP and UGT1A1 (hepatic only at doses higher than those obtained in the clinic)
Possible decrease of clinical efficacy.
Monitor for clinical efficacy.
2C19 and 3A4
2C19 in vitro
Give ledipasvir/sofosbuvir simultaneously with the proton-pump inhibitor. Proton-pump inhibitors should not be taken before taking ledipasvir/sofosbuvir.
Recommended dosage : doses comparable to omeprazole 20 mg QD either dexlansoprazole 30 mg; esomeprazole 20 mg; lansoprazole 30 mg; pantoprazole 40 mg; rabeprazole 20 mg.
See Lepidasvir/sofosbuvir + Omeprazole.
Equivalent doses to omeprazole 20 mg: dexlansoprazole 30 mg; esomeprazole 20 mg; lansoprazole 30 mg; pantoprazole 40 mg; rabeprazole 20 mg.