Harvoni and long-acting PPIs such as Omeprazole, etc.

[coloradogirl]

The day I started Harvoni, my doctor asked me if I would consider not taking the Prilosec 20mg at all during treatment. He told me only one patient of his relapsed while on Harvoni, and that patient had been taking a PPI. His logic behind the recommendation is that the long acting PPI dose is designed to last for 24 hoiurs, and that it may still reduce the effectiveness of the Ledipasvir absorbtion, as the presense of acid may be requirement. So I will try to manage my symptoms with just Tumms before bed, and well after I take my morning Harvoni.  Since Harvoni is so new to the market, I will heed his recommendation.

[Chey]

I also take Omeprazole. I started Harvoni March 1. My doctor told me since I only take 20mgs of the Omeprazole once a day is was ok to take with the Harvoni. But, I have to take them together first thing in the morning on an empty stomach. I have been doing that and it is working well so far.

[pl1952]

I just took my first Harvoni pill this morning.  I take 20 mg. of Omeprazole daily.  My doctor confirmed, just as Chey stated, that I have to take both Harvoni and the Omeprazole simultaneously on a fasted basis and then an hour after I can eat.  So I take the pills at 7am upon waking (which is fasted) and then eat breakfast an hour later.  I also called Gilead to double check -- they said that is correct...

[coloradogirl]

I, myself, just got straightened out on the what the scoop is on antacids and omeprazole. Thank you.

The Kaiser Permanente prescription information that came with the drug states that "antacids should be taken 4 hours before or 4 hours after this medication." It goes on to state that "Famotidine and omeprazole may prevent ledipasvir from working. Ask your doctor of pharmacist how to use these medications safely."

According to this document, you are correct in fasting before taking both drugs simultaneously:   http://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=f4ec77e4-bae8-4db0-b3d5-bde09c5fa075&type=display#section-7

I also looked at a study that stated:
"ledipasvir peak plasma concentration Cmax decreased by 11% and AUC decreased by just 4%."
It goes on to state:
"MANAGEMENT: Proton-pump inhibitors at doses comparable to omeprazole 20 mg or lower can be administered simultaneously with ledipasvir-sofosbuvir under fasted conditions."    http://www.drugs.com/drug-interactions/harvoni-with-omeprazole-3567-16903-1750-0.html

All that being said, my doctor's advice stems from his concern that his patient relapsed, and the only contraindication is that he was taking Prilosec. If there is anything that I can do to reduce the chance of relapse for me, I'm going to do it. 

[davidsconfused]

I quit omeprazole before I started Harvoni. Each one lasts me for three days and a couple hours (same with Nexium and Prilosec). I tried to tell this to my doctors office but I don't think they grasped what I was trying to tell them. I'm really paying the price for not taking it, but I'll just live without it. I want this to work.

[Lynn K]

I miss my PRILOSEC but have survived the last 16 weeks and just 8 more to go. So jet taking tums no closer that 4 hours away from Harvoni