Moderate
Cyanocobalamin × Esomeprazole
Vitamins. Haemopoietic stimulants×Drugs for peptic ulcer and GORD. Proton pump inhibitors
Mechanism
Esomeprazole suppresses gastric acidity, reducing release of B12 from food (which requires HCl and pepsin). With over 2 years of therapy, B12 deficiency risk is reported.
Symptoms
Fatigue, pallor, paraesthesias in hands and feet, gait instability, memory decline. Develops over 2–4 years of unrecognised therapy.
Management
On long-term PPIs (over 2 years), check B12 yearly. Oral cyanocobalamin tablets or drops can be given regardless of acidity (passive diffusion absorption at high doses). Alternative: H2-blockers (famotidine) for short-term acid suppression.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.