I need a definitive answer on this. Just got back from an upper GI endoscopy and the doc found reflux esophagitis and wants me to do an 8-week course of a PPI (Prilosec, or omeprazole.) I just started Scemblix about 7 weeks ago, and I haven't yet had a PCR to let me know how I'm doing. I really don't want to mess things up! The Scemblix patient insert info doesn't list this as a contraindication, and my GI guy says he's not aware of any reason not to do it. But, AI and Google say no, no, no. You need the acid in your stomach for absorption of the Scemblix. My mother and her mother both died of esophageal cancer, so I started being followed by a gastroenterologist (and having periodic endoscopies) when I got to middle age. I've always had a bit of erythema, but not like this report. Plus, I have increasingly had reflux symptoms. I can remember vividly my grandmother's continually clearing her throat - I do this a LOT now. I have a persistent mostly morning cough. My speaking voice is shot. So, you can see that I am certainly scared and motivated to follow through on healing the esophagitis and taking next (preventive) steps. I've got an email in to my onc. But I'll ask here: What's the truth on taking these two drugs in the same day? The PPI is extended release, so that kind of nixes separating them being the answer. Thanks for any help!
You are here
Scemblix and Prilosec (Omeprazole)
You are fine to take a proton pump inhibitor with asciminib. I know that’s not the case with a lot of TKIs, but it is fine with asciminib.
I have had this confirmed with a consultant haematology pharmacist here in the UK, but even more definitive than that you can read from the horses mouth:
https://www.novartis.com/ca-en/sites/novartis_ca/files/scemblix_pm_20250...
> “Effect of acid-reducing agents on asciminib: Co-administration of a proton pump inhibitor,
rabeprazole, had no effect on the AUC and Cmax of asciminib.”
David.
Thanks, David. The reading I've done on this overnight is just all over the place. Also, I'm no chemist! I appreciate your checking with the pharmacist and sending the link. In Section 9.2 they go over the interaction with CYP3A4, which is the problem with asciminib. It seems that the uptake is affected, even for asciminib. I think CYP2C9 is also a problem between the two. At any rate, I heard from my onc early this morning that he definitely doesn't like the situation, but thinks I'll be OK if I separate them by 12 hours. This is like a living Rubik's cube! My levothyroxine doc wants me to take that completely alone and fasting, candesartan (hypertension) is better at bedtime, asciminib has to be fasting, etc. I guess if I stay up all day and night, never eat anything, and take a pill separately every 3 hours, I'll be fine. LOL
Hi, Kat, I'm really sorry to hear this! I've been struggling with acid reflux for several years. I now take fomatidine around 11 am. I take my 150mg once a day nilotinib at 9 pm, and I'm maintaining CMR. Fingers crossed. On the other hand, when it was evil, I took a PPI for a month and had the same result. Who knows? I laughed when I read your last sentence. It's the truth, timing of foods and medications is nuts!
How were your numbers before you started asciminib? And why did you change!? I miss a few months of posts and miss a lot!
I'd be more afraid of esophageal cancer at this point. If necessary, I'd consider stopping the TKI for 8 weeks to do the PPI. That's just me.
Whatever you decide, good luck, and please let us know how things are going.
Pat
Pat - How nice to hear from you! I think of you more often than I post. H2 antagonists like fomatidine could be a way around this conundrum, but I think right now, for the 8 week "healing" period, the gastroenterologist wants omeprazole. With my family history, I always worried the day might come that I'd get the verdict back that they had found Barrett's, but as I had never had any heartburn symptoms, I thought I might be OK. This time, it's still not Barrett's, but the cells have definitely changed to columnar, so it's like pre-Barrett's. Anyway, there's nothing I can do but follow doctor's orders and recheck. The symptoms I DO have are all laryngeal/pharyngeal, and they have indeed gotten better on omeprazole. My PC is down on the corrective surgery - she has several patients who have had it and now have bad problems with getting food down and nausea. My old gastroenterologist (many years ago, granted) said, "it doesn't work." Since it's now 2025, I'm going to ask about some genetic testing for esophagus cancer markers. It could be helpful, either way.
It's great to hear your PCR didn't change on the PPI! As I said to Joe, that's what I want to hear. In mid-November I'll find out. I'll also be finding out if the Omeprazole has returned me to neutral (benign) territory with the esophagus. I'll shoot y'all an update then.
Prior to the switch to asciminib I had my lovely "two zeroes to the right" of the decimal point on the PCR for about 8 years, so there was no reason to switch from 20 mg dasatinib. I did it for a number of reasons: Like a lot of us, I had been following the development of ABL001 and hoped it would be the very best TKI of all. My only complaint for dasatinib (as for most of the Gen 1 and 2 ones) was the puffy eyes (also pleural effusions, but the minimal residual fluid had finally - after years! - seemed to have resolved,) But the puffy eyes (and jawline/cheeks) REALLY bothered me and never stopped making me very unhappy, even as old as I am. Quite improved over imatinib, and tolerable, but still, wanted to try. I also was curious to see if I could get an undetectable on the PCR. My two forays into TFR were spectacularly swift and definitive faceplants, even though I am a poster girl for success on paper. Since asciminib is completely different, maybe it will knock the damn LSCs to their knees. Who knows.
Anyway, I've been extremely happy on 20 mg Scemblix once a day, and hope I can stay on it. No initial side effects or adverse events so far. And, best of all, my old eyes and jawline are back! Since 2009 I've accumulated wrinkles and sags, but the difference, to me, is enormous. I don't look like I've been on a bender 24-7 anymore. I just look like an OK old lady who probably used to be sort of pretty. I think the culprits for the puffy eyelids (and other collagen-dependent structures) that most of the Gen 1 and 2 TKIs share are PDGFR and SAR, as the unintended off-targets; asciminib doesn't affect those.
Now, if I can just stick to the baby-like feeding schedule 3 fasting-required meds force me into, life will be grand!
Kathy
Kat,
Have you started with omeprazole yet? If so can you let us know how your BCR/ABL goes in mid November. I ask because, as I mentioned in my earlier response, my numbers dropped significantly while on that drug. I had read somewhere, but I can’t find it now, that some Japanese group had found a beneficial effect of omeprazole in conjunction with Imatinib. I am curious to see how it goes for you.
JP
Yes, I started omeprazole on Sept 22nd. I had been on Scemblix about 6-1/2 weeks by then. My next PCR will be on Nov 13th. I’ll let you know!