Summary

Vortioxetine and lansoprazole have a potential pharmacokinetic interaction through CYP enzyme pathways. While generally considered a minor interaction, monitoring may be warranted when these medications are used concurrently, particularly in patients who are poor CYP2D6 metabolizers.

Introduction

Vortioxetine (Trintellix) is a multimodal antidepressant used to treat major depressive disorder, working through serotonin reuptake inhibition and modulation of various serotonin receptors. Lansoprazole (Prevacid) is a proton pump inhibitor (PPI) commonly prescribed for gastroesophageal reflux disease (GERD), peptic ulcers, and other acid-related disorders. Both medications are frequently prescribed and may be used together in patients with comorbid depression and gastrointestinal conditions.

Mechanism of Interaction

The interaction between vortioxetine and lansoprazole occurs primarily through cytochrome P450 enzyme pathways. Vortioxetine is metabolized mainly by CYP2D6, with minor contributions from CYP3A4/5, CYP2C19, and CYP2C9. Lansoprazole is metabolized by CYP2C19 and CYP3A4, and can act as a weak inhibitor of CYP2C19. While lansoprazole does not significantly inhibit CYP2D6, it may have minor effects on other metabolic pathways that could theoretically influence vortioxetine clearance, though this interaction is generally considered clinically insignificant.

Risks and Symptoms

The clinical significance of the vortioxetine-lansoprazole interaction is generally low to minimal. Most patients can safely use these medications together without significant adverse effects. However, potential risks may include slightly increased vortioxetine exposure in some patients, which could theoretically lead to enhanced side effects such as nausea, dizziness, or sexual dysfunction. Patients who are poor CYP2D6 metabolizers may be at slightly higher risk for increased vortioxetine levels. The interaction is not expected to cause serious adverse events or require routine dose adjustments.

Management and Precautions

Routine monitoring is generally not required when vortioxetine and lansoprazole are co-administered. Healthcare providers should be aware of the patient's response to vortioxetine therapy and monitor for any unusual increase in side effects when lansoprazole is initiated or discontinued. Patients should be counseled to report any new or worsening symptoms. Dose adjustments of vortioxetine are typically unnecessary unless clinically indicated by patient response. Consider the patient's CYP2D6 metabolizer status if known, as poor metabolizers may require closer monitoring. Alternative PPI options are generally not necessary unless other clinical factors warrant a change.

Vortioxetine interactions with food and lifestyle

Vortioxetine can be taken with or without food. However, patients should avoid excessive alcohol consumption while taking vortioxetine, as alcohol may increase the risk of central nervous system side effects such as drowsiness, dizziness, and impaired coordination. Additionally, patients should use caution when driving or operating machinery, especially when first starting treatment or when the dose is changed, as vortioxetine may cause drowsiness or affect alertness.

Lansoprazole interactions with food and lifestyle

Lansoprazole should be taken on an empty stomach, preferably 30-60 minutes before meals, as food can significantly reduce its absorption and effectiveness. Alcohol consumption should be limited or avoided while taking lansoprazole, as alcohol can increase stomach acid production and counteract the medication's acid-reducing effects. Additionally, alcohol may worsen gastroesophageal reflux disease (GERD) symptoms that lansoprazole is intended to treat.