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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

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